A Pilot Randomized Trial Comparing Weaning From Mechanical Ventilation on Pressure Support Versus Proportional Assist Ventilation*

Bosma, Karen J.; Read, Brooke; Nikoo, Mohammad; Jones, Philip M.; Priestap, Fran; Lewis, James F.

doi:10.1097/ccm.0000000000001600

Cited by 49 publications

(76 citation statements)

References 15 publications

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“…PAV as compared to pressure-controlled conventional ventilation has been shown to reduce the OI in infants with respiratory distress syndrome [5] and to reduce the OI, peak and MAP and the work of breathing (as measured by PTPdi) in infants with evolving or established BPD [6][7][8]. Although there have been no randomised controlled trials of PAV in neonates, in adults, PAV versus pressure support ventilation resulted in a shorter duration of intensive care days [9]. NAVA has also been shown to have advantages over conventional ventilation in prematurely born infants.…”

Section: Discussionmentioning

confidence: 99%

“…The results of short-term studies [5][6][7][8][9][10][11][12][13][14][15] suggest that both PAV and NAVA improved oxygenation and were associated with lower airway pressures compared to conventional or other triggered modes of ventilation in prematurely born infants with evolving BPD, otherwise known as chronic pulmonary insufficiency of prematurity (CPIP) [16]. There are no studies in that population comparing PAV and NAVA, and hence the aim of this study was to compare the effect of PAV and NAVA on the oxygenation index in infants with evolving or established BPD.…”

Section: Introductionmentioning

confidence: 99%

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Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

2020

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Both proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) provide pressure support synchronised throughout the respiratory cycle proportional to the patient's respiratory demand. Our aim was to compare the effect of these two modes on oxygenation in infants with evolving or established bronchopulmonary dysplasia. Two-hour periods of PAVand NAVA were delivered in random order to 18 infants born less than 32 weeks of gestation. Quasi oxygenation indices ("OI") and alveolararterial ("A-a") oxygen gradients at the end of each period on PAV, NAVA and baseline ventilation were calculated using capillary blood samples. The mean "OI" was not significantly different on PAV compared to NAVA (7.8 (standard deviation (SD) 3.2) versus 8.1 (SD 3.4), respectively, p = 0.70, but lower on both than on baseline ventilation (mean baseline "OI" 11.0 (SD 5.0)), p = 0.002, 0.004, respectively). The "A-a" oxygen gradient was higher on PAV and baseline ventilation than on NAVA (20.8 (SD 12.3) and 22.9 (SD 11.8) versus 18.5 (SD 10.8) kPa, p = 0.015, < 0.001, respectively). Conclusion: Both NAVA and PAV improved oxygenation compared to conventional ventilation. There was no significant difference in the mean "OI" between the two modes, but the mean "A-a" gradient was better on NAVA. What is Known: • Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) can improve the oxygenation index (OI) in prematurely born infants. • Both PAV and NAVA can provide support proportional to respiratory drive or demand throughout the respiratory cycle. What is New: • In infants with evolving or established BPD, using capillary blood samples, both PAV and NAVA compared to baseline ventilation resulted in improvement in the "OI", but there was no significant difference in the "OI" on PAV compared to NAVA. • The "alveolar-arterial" oxygen gradient was better on NAVA compared to PAV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

2020

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“…The stimulator comprised a single-compartment based on a report by Beloncle and colleagues [14]. The conditions of respiratory mechanics were adjusted to simulate an adult patient placed in the semi-recumbent position (inclination of 45° [14][15][16]. The following parameters were based on a previous report [17].…”

Section: Lung Modelsmentioning

confidence: 99%

Bench investigation of the accuracy of the dynamic approach in respiratory mechanics during noninvasive ventilation with different pressure support levels

Chen

Yuan

Zhang

et al. 2020

Preprint

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Background: Under the dynamic conditions of non-invasive mechanical ventilation, respiratory system mechanics parameters, including compliance (Crs) and airway resistance (Rrs), are affected by systemic and ventilator parameters. We evaluated the accuracy of respiratory mechanics in the dynamic approach in different lung disease models during pressure support ventilation (PSV).Methods: A Respironics V60 ventilator was connected to an active lung simulator for modeling four profiles of respiratory mechanics: normal, restrictive, obstructive and mixed obstructive/restrictive. PSV and positive end-expiration pressure (PEEP) were 2-25 cmH2O and 5 cmH2O, respectively. Measurements were performed with an air leak of 25-28 L/min. Ventilator performance and patient-ventilator asynchrony were evaluated by measuring flow, airway pressure, and volume. Crs and inspiratory/expiratory resistance (Rinsp/Rexp) were calculated by dynamic approach. Results: Crs was overestimated with pressure support (PS) at 5 cmH2O. Peak inspiratory/expiratory flow (PIF/PEF) and tidal volume (VT) was increased with PS level, while calculated Crs was decreased. At PS 10-15 cmH2O, the difference between calculated and preset Crs was ≤20% in higher resistance models (obstructive and mixed). In normal resistance conditions (restrictive and normal), the calculated Crs was always larger than the preset value significantly regardless of PS. Underestimations of Rinsp and Rexp were observed at PS 5-10 cmH2O. The calculation error might be controlled within 10% when PS above 15 cmH2O in higher resistance models. Conclusion: Higher gas flow is beneficial for Rrs estimation by using dynamic approach, whereas the calculation of Crs is always overestimated in normal resistance conditions.

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“…And this understanding helps one to appreciate other modes with the same capability and that have other desirable capabilities, such as neurally adjusted ventilatory assist 7 and proportional assist ventilation. 8 Time to nip this dogma in the bud.…”

Section: To the Editormentioning

confidence: 99%

Asynchrony Between Fact and Dogma

Chatburn

2018

Respir Care

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A Pilot Randomized Trial Comparing Weaning From Mechanical Ventilation on Pressure Support Versus Proportional Assist Ventilation*

Cited by 49 publications

References 15 publications

Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

Bench investigation of the accuracy of the dynamic approach in respiratory mechanics during noninvasive ventilation with different pressure support levels

Asynchrony Between Fact and Dogma

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