Electrical Activity of the Diaphragm during Pressure  Support Ventilation in Acute Respiratory Failure

Beck, Jennifer; Gottfried, S. B.; Navalesi, Paolo; Skrobik, Yoanna; Comtois, Norman; Rossini, Mauro; Sinderby, Christer A.

doi:10.1164/ajrccm.164.3.2009018

Cited by 174 publications

(136 citation statements)

References 23 publications

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“…Neural inspiratory time (T in ) was defined, according to previously published NAVA studies [13][14][15]19], as the time difference between the initial increase and the maximal value of EAdi (EAdi max ). Details on this point are given in the Electronic Supplementary Material.…”

Section: Measurementsmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d ), the patient's neural inspiratory time (T in ), ventilator pressurization duration (T iv ), inspiratory time in excess (T iex ), number of asynchrony events per minute and asynchrony index (AI) were determined. Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO 2 and PaCO 2 were not different between ventilatory modes. Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

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Section: Measurementsmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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“…15 Moreover, the patient's neuro-ventilatory coupling needs to be intact in order for the intensity of the EA di signal (as an expression of the neuronal activity of the respiratory center) to be proportional to the patient's ventilatory requirement. This implies that all the receptors of the respiratory system's feedback mechanism are sufficiently functional and that their signals are interpreted correctly by the respiratory center.…”

Section: The Importance Of Patient-ventilator Synchronymentioning

confidence: 99%

Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

Verbrugghe

Jorens

2011

Respir Care

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Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The implementation of NAVA requires the introduction of a catheter to measure the electrical activity of the diaphragm (EA di ). NAVA relies, opposite to conventional assisted ventilation modes, on the EA di to trigger the ventilator breath and to adjust the ventilatory assist to the neural drive. The amplitude of the ventilator assist is determined by the instantaneous EA di and the NAVA level set by the clinician. The NAVA level amplifies the EA di signal and determines instantaneous ventilator assist on a breath-to-breath basis. Experimental and clinical data suggest superior patient-ventilator synchrony with NAVA. Patient-ventilator asynchrony is present in 25% of mechanically ventilated patients in the intensive care unit and may contribute to patient discomfort, sleep fragmentation, higher use of sedation, development of delirium, ventilator-induced lung injury, prolonged mechanical ventilation, and ultimately mortality. With NAVA, the reliance on the EA di signal, together with an intact ventilatory drive and intact breathing reflexes, allows integration of the ventilator in the neuro-ventilatory coupling on a higher level than conventional ventilation modes. The simple monitoring of the EA di signal alone may provide the clinician with important information to guide ventilator management, especially during the weaning process. Although, until now, little evidence proves the superiority of NAVA on clinically relevant end points, it seems evident that patient populations (eg, COPD and small children) with major patient-ventilator asynchrony may benefit from this new ventilatory tool.

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“…Several publications have shown that there is usually a good correlation between the intensity of diaphragmatic electromyogram and transdiaphragmatic pressure. 15,16 Thus, the measure of E di could be useful to estimate the progression of a patient's inspiratory effort during recovery from Guillain-Barré syndrome. Nonetheless, further studies are needed to assess the safety of NAVA in patients with Guillain-Barré syndrome and to evaluate the best time to start the weaning process with this modality.…”

Section: Discussionmentioning

confidence: 99%

Neurally Adjusted Ventilatory Assist During Weaning From Respiratory Support in a Case of Guillain-Barré Syndrome

et al. 2014

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We report a case of Guillain-Barré syndrome complicated by respiratory failure requiring mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) allowed proper patient-ventilator synchronization by pressure support proportional to the electrical activity of the diaphragm (E di ). Prolonged ventilation with NAVA seems feasible in patients with neuromuscular impairment, but the weaning process conducted by a continuous monitoring of E di for pressure support titration needed to be assessed in a Guillain-Barré syndrome patient. Beginning on day 12 after hospital admission, the patient was ventilated with NAVA for 8 d. The NAVA level (pressure support per unit of E di ) was decreased from 1.2 cm H 2 O/V to zero over the 8-d period. A simultaneous decrease in the tidal volume/E di ratio was interpreted as a sign of recovery. A spontaneous breathing trial was successfully performed on day 20, followed by decannulation 4 d later. In conclusion, NAVA should be further investigated in patients with Guillain-Barré syndrome, particularly during the weaning period.

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Electrical Activity of the Diaphragm during Pressure Support Ventilation in Acute Respiratory Failure

Cited by 174 publications

References 23 publications

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

Neurally Adjusted Ventilatory Assist During Weaning From Respiratory Support in a Case of Guillain-Barré Syndrome

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