Cardiorespiratory effects of NIV‐NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: A randomized crossover trial

Abstract

Objective Investigate the cardiorespiratory effects of noninvasive neurally adjusted ventilatory assist (NIV‐NAVA), nonsynchronized nasal intermittent positive pressure ventilation (NIPPV), and nasal continuous positive airway pressure (NCPAP) shortly after extubation. Hypothesis Types of noninvasive pressure support and the presence of synchronization may affect cardiorespiratory parameters. Study Design Randomized crossover trial. Patient–Subject Selection Infants with birth weight (BW) 1250 g or under, undergoing their first planned extubation were randomly assigned to all three modes using a computer‐generated sequence. Methodology Electrocardiogram and electrical activity of the diaphragm (Edi) were recorded for 30 min on each mode. Analysis of heart rate variability (HRV), diaphragmatic activity (Edi area, breath area, amplitude, inspiratory and expiratory times), and respiratory variability were compared between modes. Results Twenty‐three infants had full data recordings and analysis: Median (IQR) gestational age = 25.9 weeks (25.2–26.4), BW = 760 g (595–900), and postnatal age 7 (4–19) days. There were no differences in HRV between modes. A significantly reduced Edi area and breath amplitude, and increased coefficient of variation (CV) of breath amplitude were observed during NIV‐NAVA and NIPPV compared to NCPAP. A higher proportion of assisted breaths (99% vs. 51%; p < .001) provided a higher mean airway pressure (MAP; 9.4 vs. 8.2 cmH2O; p = .002) with lower peak inflation pressures (PIPs; 14 vs. 16 cmH2O; p < .001) during NIV‐NAVA compared to NIPPV. Conclusions NIV‐NAVA and NIPPV applied shortly after extubation were associated with lower respiratory efforts and higher respiratory variability. These effects were more evident for NIV‐NAVA where optimal patient–ventilator synchronization provided a higher MAP with lower PIPs.

Non-invasive neurally-adjusted ventilatory assist in preterm infants with respiratory distress: a systematic review and meta-analysis

“…The mechanism of low treatment failure rate of NIV-NAVA was presumed that it decreases work of breathing by improving patient-ventilator synchrony and reduces apnea by effective backup ventilation [26]. Some previous studies have reported that NIV-NAVA shortens inspiratory trigger delay [10], decreases asynchrony [9] and reduces peak inspiratory pressures, FiO2, and frequency and length of desaturation compared to other NIV modality [11], resulting in decreased respiratory efforts in premature infants [38]. Furthermore, in preterm infants, one of the significant reasons for reintubation is apnea [46].…”

Noninvasive neurally adjusted assisted ventilation as weaning mode in extremely preterm infants: a meta-analysis and systematic review

“…Lee et al 40 conducted a randomized study and suggested that NIV-NAVA decreased all asynchrony events by more than fivefold per minutes and the median asynchrony index was 19.7%. Second, NIV-NAVA has been associated with reduced peak inspiratory pressure and work of breathing after extubation [39][40][41][42] . It can facilitate attainment of the required tidal volume while simultaneously minimizing airway pressure, which can protect the lung and airway from damage.…”

Pediatric pulmonology year in review 2021 and 2022: Physiology

“…Noninvasive neurally adjusted ventilatory assist (NIV‐NAVA) uses the diaphragm electrical activity signal to deliver synchronized mechanical inflations to improve interaction between the patient and ventilator. Latremouille et al 59 compared the cardiorespiratory effects of NIV‐NAVA to nasal continuous positive airway pressure (NCAP) and noninvasive positive pressure ventilation (NIPPV) in extremely preterm infants shortly after extubation. The results of this prospective crossover randomized trial showed that during the short postextubation study period, differences in physiological effects between NIV‐NAVA, NCPAP, and NIPPV were not reflected by changes in heart rate variability.…”