Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury*

Allo, Jean-Christophe; Beck, Jennifer; Brander, Lukas; Brunet, F.; Slutsky, Arthur S.; Sinderby, Christer A.

doi:10.1097/01.ccm.0000242520.50665.9f

Cited by 94 publications

(107 citation statements)

References 53 publications

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“…11 In contrast to PSV, NAVA prevents excessive P aw and V T values, because EAdi undergoes down-regulation in response to increasing assistance levels, thereby decreasing the amount of assistance provided. 13,14,19,48,49 In a recent comparison of the impact of NAVA and PSV on sleep architecture, we demonstrated that NAVA provided better sleep quality in terms of REM sleep, fragmentation index, and ineffective efforts in unsedated adults. 18 NAVA also allows considerable variability in the breathing pattern (ie, better replicates the variability of spontaneous breathing).…”

Section: Discussionmentioning

confidence: 99%

Effect of Ventilatory Variability on Occurrence of Central Apneas

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Effect of Ventilatory Variability on Occurrence of Central Apneas

et al. 2013

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“…In 3-kg rabbits, Allo et al 56 found that NAVA could effectively unload respiratory muscles without increasing tidal volume. NAVA, compared to PSV, also decreased diaphragm electrical activity and transdiaphragmatic pressure-time product (P Ͻ .05) in lung-injured rabbits, 57 and reduced the incidence and severity of ventilator-induced lung injury in rabbits.…”

Section: Animal Datamentioning

confidence: 99%

Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist

Kacmarek

2011

Respir Care

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Patient-ventilator synchrony is a common problem with all patients actively triggering the mechanical ventilator. In many cases synchrony can be improved by vigilant adjustments by the managing clinician. However, in most institutions clinicians are not able to spend the time necessary to ensure synchrony in all patients. Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) were both developed to improve patient-ventilator synchrony by proportionally unloading ventilatory effort and turning control of the ventilatory pattern over to the patient. This paper discusses PAV's and NAVA's theory of operation, general process of application, and the supporting literature.

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“…Titration of the PEEP level in accordance with the EA di signal could optimize the respiratory pattern and reduce tonic diaphragm activity, allowing the patient to maintain spontaneous ventilation in NAVA. 30,31 Observational data from small populations suggest that NAVA in these patients is feasible and seems well tolerated. 32,33 …”

Section: Titration Of the Peep Level And Tonic Diaphragm Activitymentioning

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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Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury*

Cited by 94 publications

References 53 publications

Effect of Ventilatory Variability on Occurrence of Central Apneas

Effect of Ventilatory Variability on Occurrence of Central Apneas

Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist

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

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