Effort-adapted modes of assisted breathing

Moerer, Onnen

doi:10.1097/mcc.0b013e32834f3e8a

Cited by 13 publications

(11 citation statements)

References 135 publications

(122 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The new challenge in developing ventilation strategies thus consists of minimizing the risk of lung injury, avoiding disuse atrophy of the diaphragm, and improving the match between the patient's needs and the assistance delivered by the ventilator [6]. New ventilation modes have been designed to meet this challenge [5], and NAVA is a pressure-assisted mode in which the pressure delivered by the ventilator is proportional to the electrical activity of the diaphragm recorded continuously through an esophageal probe [18].…”

Section: Main Problems With Conventional Ventilation Modalities In Thmentioning

confidence: 99%

See 1 more Smart Citation

Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference

et al. 2012

View full text Add to dashboard Cite

Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe. In clinical settings, NAVA has been chiefly compared with pressure-support ventilation, one of the most popular modes used during the weaning phase, which delivers a constant pressure from breath to breath. Comparisons with proportional-assist ventilation, which has numerous similarities, are lacking. Because of the constant level of assistance, pressure-support ventilation reduces the natural variability of the breathing pattern and can be associated with asynchrony and/or overinflation. The ability of NAVA to circumvent these limitations has been addressed in clinical studies and is discussed in this report. Although the underlying concept is fascinating, several important questions regarding the clinical applications of NAVA remain unanswered. Among these questions, determining the optimal NAVA settings according to the patient's ventilatory needs and/or acceptable level of work of breathing is a key issue. In this report, based on an investigator-initiated round table, we review the most recent literature on this topic and discuss the theoretical advantages and disadvantages of NAVA compared with other modes, as well as the risks and limitations of NAVA.

show abstract

Section: Main Problems With Conventional Ventilation Modalities In Thmentioning

confidence: 99%

“…To improve the match between the patient's needs and the assistance delivered by the ventilator, manufacturers have developed several new modes of MV [5,6]. Among these new modes we identified proportional-assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA).…”

Section: Introductionmentioning

confidence: 99%

Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Although pressure support ventilation (PSV) is one of the most commonly used modes of assisted spontaneous breathing, several other modalities have been made available (6), including neurally adjusted ventilatory assist (NAVA) (7,8). During NAVA, as opposed to other ventuatory modes, the Critical Care Medicine www.ccmjournal.org ventilator is driven by the electrical activity of the crural diaphragm (Eadi) of the patient (9).…”

mentioning

confidence: 99%

Estimation of Patient’s Inspiratory Effort From the Electrical Activity of the Diaphragm*

Bellani

Mauri

Coppadoro

et al. 2013

Critical Care Medicine

151

143

View full text Add to dashboard Cite

show abstract

“…But the level of support is fixed and must be manually changed. New approaches like adaptive support ventilation, proportional assist ventilation, and neurally adjusted ventilatory assist are examples of techniques oriented to adapt the assist to a defined target, instantaneous changes in respiratory drive, or lung mechanics [6].…”

Section: Introductionmentioning

confidence: 99%

Non-invasive determination of respiratory effort in spontaneous breathing and support ventilation: a validation study with healthy volunteers

Lopez-Navas

Brandt²,

Strutz

et al. 2014

Biomedical Engineering / Biomedizinische Technik

View full text Add to dashboard Cite

The proper setting of support ventilation aims to follow the patients' demands, ensuring adequate assistance to their respiratory effort. Effort assessment is thus necessary. But invasive procedures like measuring transdiaphragmatic pressure (Pdi) are impractical in long-term ventilation. Our purpose was therefore the development of the Occlusion+Delta (O+D) method for non-invasive continuous assessment of effort, quantified by the inspiratory pressure-time-product (PTPinsp), during ventilatory support. Flow and airway pressure were measured from 25 healthy volunteers at three effort levels. For the non-invasive method, short expiratory occlusions were executed each three to seven cycles to estimate resistance and compliance with a fitting algorithm fed with the differences between occluded and undisturbed cycles. Signals and estimates were then used to calculate the effort. For the validation of O+D, its estimations were compared to the results from invasive measurement of Pdi using balloon catheters. The agreement between PTPinsp from the invasive measurement and the proposed alternative was confirmed by regression analysis (PTP(O+D)=1.13PTP(Pdi)- 0.85, R²=0.84) and calculation of their differences (mean±SD=1.78±7.18 cm H2O s). Repeated execution of the non-invasive O+D method facilitates a safe automatic assessment of respiratory mechanics and breathing effort, promoting the rapid recognition of changes in patient's demands and the adaptation of support.

show abstract

Effort-adapted modes of assisted breathing

Cited by 13 publications

References 135 publications

Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference

Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference

Estimation of Patient’s Inspiratory Effort From the Electrical Activity of the Diaphragm*

Non-invasive determination of respiratory effort in spontaneous breathing and support ventilation: a validation study with healthy volunteers

Contact Info

Product

Resources

About