Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants

Houtekie, Laurent; Moerman, Damien; Bourleau, Amaury; Reychler, Grégory; Detaille, Thierry; Derycke, Emilien; Cléty, Stéphan Clément de

doi:10.4187/respcare.03624

Cited by 18 publications

(23 citation statements)

References 18 publications

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“…Wasted efforts were also decreased, suggesting that NIV-NAVA is feasible and well tolerated in PICU patients and improves patient-ventilator synchrony. These results have been fully confirmed by another study performed in infants ventilated after cardiac surgery, comparing NIV-NAVA with nasal-CPAP [25].…”

Section: Noninvasive Ventilation In Pediatric Icusupporting

confidence: 83%

Mechanical ventilation for children

Conti

Piastra²

2016

Current Opinion in Critical Care

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Despite the improvement observed in the last decades in the treatment of pediatric acute respiratory failure and the diffusion of innovative modes of mechanical ventilation, there are no clear and consistent guidelines for the use of mechanical ventilation for children. In several areas data are still lacking, and in many others they are extrapolated from studies performed in adults; the direct evaluation of results obtained from studies specific to the pediatric population is therefore crucial.

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Section: Noninvasive Ventilation In Pediatric Icusupporting

confidence: 83%

Mechanical ventilation for children

Conti

Piastra²

2016

Current Opinion in Critical Care

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“…NAVA can be used in infants receiving postoperative mechanical ventilation after congenital heart surgery, as previously reported [7–10]. Infants included in this study all weighed less than 10 kg and had been operated less than 24 h before.…”

Section: Discussionmentioning

confidence: 92%

Physiological effects of invasive ventilation with neurally adjusted ventilatory assist (NAVA) in a crossover study

Liet¹,

Barrière²,

Roux³

et al. 2016

BMC Pediatr

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BackgroundNeurally Adjusted Ventilatory Assist (NAVA) is a mode of assisted mechanical ventilation that delivers inspiratory pressure proportionally to the electrical activity of the diaphragm. To date, no pediatric study has focused on the effects of NAVA on hemodynamic parameters. This physiologic study with a randomized cross-over design compared hemodynamic parameters when NAVA or conventional ventilation (CV) was applied.MethodsAfter a baseline period, infants received NAVA and CV in a randomized order during two consecutive 30-min periods. During the last 10 min of each period, respiratory and hemodynamic parameters were collected. No changes in PEEP, FiO2, sedation or inotropic doses were allowed during these two periods. The challenge was to keep minute volumes constant, with no changes in blood CO2 levels and in pH that may affect the results.ResultsSix infants who had undergone cardiac surgery (mean age 7.8 ± 4.1 months) were studied after parental consent. Four of them had low central venous oxygen saturation (ScvO2 < 65 %). The ventilatory settings resulted in similar minute volumes (1.7 ± 0.4 vs. 1.6 ± 0.6 ml/kg, P = 0.67) and in similar tidal volumes respectively with NAVA and with CV. There were no statistically significant differences on blood pH levels between the two modes of ventilation (7.32 ± 0.02 vs. 7.32 ± 0.04, P = 0.34). Ventilation with NAVA delivered lower peak inspiratory pressures than with CV: -32.7 % (95 % CI: -48.2 to –17.1 %, P = 0.04). With regard to hemodynamics, systolic arterial pressures were higher using NAVA: +8.4 % (95 % CI: +3.3 to +13.6 %, P = 0.03). There were no statistically significant differences on cardiac index between the two modes of ventilation. However, all children with a low baseline ScvO2 (<65 %) tended to increase their cardiac index with NAVA compared to CV: 2.03 ± 0.30 vs. 1.91 ± 0.39 L/min.m2 (median ± interquartile, P = 0.07).ConclusionsThis pilot study raises the hypothesis that NAVA could have beneficial effects on hemodynamics in children when compared to a conventional ventilatory mode that delivered identical PEEP and similar minute volumes.Trial registrationClinicalTrials.gov Identifier: NCT01490710. Date of registration: December 7, 2011.

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“…Monitoring esogastric pressure offers another way to improve patient–ventilator interaction during NIV. In infants 82 and children 19 , esophageal pressure measurement has been shown to be a valuable tool to assess patient–ventilator interaction and to optimize ventilatory settings ( Figure 1). …”

Section: Advances In Noninvasive Ventilationmentioning

confidence: 99%

Recent Advances in Pediatric Ventilatory Assistance

et al. 2017

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In this review on respiratory assistance, we aim to discuss the following recent advances: the optimization and customization of mechanical ventilation, the use of high-frequency oscillatory ventilation, and the role of noninvasive ventilation. The prevention of ventilator-induced lung injury and diaphragmatic dysfunction is now a key aspect in the management of mechanical ventilation, since these complications may lead to higher mortality and prolonged length of stay in intensive care units. Different physiological measurements, such as esophageal pressure, electrical activity of the diaphragm, and volumetric capnography, may be useful objective tools to help guide ventilator assistance. Companies that design medical devices including ventilators and respiratory monitoring platforms play a key role in knowledge application. The creation of a ventilation consortium that includes companies, clinicians, researchers, and stakeholders could be a solution to promote much-needed device development and knowledge implementation.

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Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants

Cited by 18 publications

References 18 publications

Mechanical ventilation for children

Mechanical ventilation for children

Physiological effects of invasive ventilation with neurally adjusted ventilatory assist (NAVA) in a crossover study

Recent Advances in Pediatric Ventilatory Assistance

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