Evaluating peak inspiratory pressures and tidal volume in premature neonates on NAVA ventilation

Abstract

Neurally adjusted ventilatory assist (NAVA) ventilation allows patients to determine their peak inspiratory pressure and tidal volume on a breath-by-breath basis. Apprehension exists about premature neonates' ability to self-regulate breath size. This study describes peak pressure and tidal volume distribution of neonates on NAVA and non-invasive NAVA. This is a retrospective study of stored ventilator data with exploratory analysis. Summary statistics were calculated. Distributional assessment of peak pressure and tidal volume were evaluated, overall and per NAVA level. Over 1 million breaths were evaluated from 56 subjects. Mean peak pressure was 16.4 ± 6.4 in the NAVA group, and 15.8 ± 6.4 in the NIV-NAVA group (t test, p < 0.001). Mean tidal volume was 3.5 ± 2.7 ml/kg. Conclusion:In neonates on NAVA, most pressures and volumes were within or lower than recommended ranges with pressure-limited or volume-guarantee ventilation. What is known: • Limiting peak inspiratory pressures or tidal volumes are the main strategies to minimize ventilator-induced lung injury in neonates. Neurally adjusted ventilatory assist allows neonates to regulate their own peak inspiratory pressures and tidal volumes on a breath-to-breath basis using neural feedback. What is new: • When neonates chose the size of their breaths based on neural feedback, the majority of peak inspiratory pressures and tidal volumes were within or lower than the recommended peak inspiratory pressure or tidal volume ranges with pressure-limited or volume guarantee ventilation. Keywords Neurally adjusted ventilatory assist (NAVA). Premature neonates. Ventilatory induced lung injury. Tidal volume. Peak pressure Abbreviations BPD Bronchopulmonary dysplasia CPAP Continuous positive airway pressure Edi Electrical activity of the diaphragm NAVA Neurally adjusted ventilatory assist NIV NAVA Non-invasive NAVA PIP Peak inspiratory pressure PS Pressure support VT Tidal volume VTV Tidal volume ventilation Communicated by Daniele De Luca

Implementation of neurally adjusted ventilatory assist and high flow nasal cannula in very preterm infants in a tertiary level NICU

“…Together with recent data published by our group, this study supports the suggestion that preterm infants exhibit functional maturity of respiratory control and have sufficient feedback mechanisms, allowing NAVA ventilation. 29,31 Most infants were switched to NAVA already on their first day of life; however, the median number of NAVA ventilation episodes was three, meaning that most of the infants also needed other invasive respiratory modes.…”

Respiratory physiology during NAVA ventilation in neonates born with a congenital diaphragmatic hernia: The “NAVA‐diaph” pilot study

“…NAVA is a ventilatory mode that delivers synchronized assisted ventilation, proportional to the respiratory drive, using the electrical activity of the patient's diaphragm (EAdi) 6 . NAVA is already being used in newborns, especially premature ones, and has been shown to have many benefits: lower peak inspiratory pressure (PIP), lower work of breathing (WOB), better patient–ventilator interaction, and better gas exchange 7–13 . The use of NAVA was also associated with a reduction of sedation, 14 which probably impacts the hemodynamic status and risk of withdrawal in infants.…”

Non-invasive neurally adjusted ventilatory assist in preterm infants with RDS: effect of changing NAVA levels

“…NAVA can be used as an invasive (via an endotracheal tube) or a non-invasive (via a nasal mask or nasal prongs: NIV-NAVA) ventilation mode [1]. Several clinical studies have shown that NAVA and NIV-NAVA are feasible, safe and effective in preterm neonates [2][3][4][5][6]. The NAVA level is the factor that converts the Edi signal in a proportional pressure.…”