Inspiratory Muscle Unloading by Neurally Adjusted Ventilatory Assist During Maximal Inspiratory Efforts in Healthy Subjects

Sinderby, Christer A.; Beck, Jennifer; Spahija, Jadranka; Marchie, Michel de; Lacroix, Jacques; Navalesi, Paolo; Slutsky, Arthur S.

doi:10.1378/chest.06-1909

Cited by 152 publications

(139 citation statements)

References 17 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: 65%

“…Subjects meeting the inclusion criteria were connected to a ventilator capable of delivering both PSV and NAVA (Servo-i, Maquet Critical Care, Sölna, Sweden). As previously described, 19 EAdi was recorded using a 16 French gastric catheter equipped with electrodes (EAdi catheter, Maquet Critical Care, Sölna, Sweden), whose correct position was checked using the "EAdi catheter positioning" ventilator function. Humidification was provided by a heat and moisture exchanger in all subjects.…”

Section: Ventilation Methodsmentioning

confidence: 99%

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Effect of Ventilatory Variability on Occurrence of Central Apneas

et al. 2013

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Section: Discussionmentioning

confidence: 65%

Section: Ventilation Methodsmentioning

confidence: 99%

Effect of Ventilatory Variability on Occurrence of Central Apneas

et al. 2013

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“…A patient with respiratory insufficiency has an excessively high EA di signal as an expression of an insufficient reserve of the neuro-ventilatory coupling, which fails to meet the patient's respiratory needs. 3,[21][22][23] The EA di signal may also vary intra-individually, depending on the stage of disease and the physiologic reserve of the respiratory system. 24 Thus, the evolution of the EA di signal can be used as a measure of the progression of the respiratory function and possibly help predict the success of weaning from mechanical ventilation.…”

Section: Interpretation Of the Diaphragm Signalmentioning

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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“…Thus, NAVA seems to decrease the risk for over-assistance since V T remains under the control of the child's central respiratory command. The child adapts his inspiratory activity to the NAVA level in order to control V T and to regulate PaCO 2 [58]. This persistence of the ventilatory adaptation under NAVA can be further demonstrated under extracorporeal membrane oxygenation where after downregulation of extracorporeal gas transfer, an immediate upregulation of ventilation was observed [59].…”

Section: Improving Patient-ventilator Synchronymentioning

confidence: 88%

Ventilating the Lungs Safely: What’s New for Infants and Children?

Corbelli

Habre

2013

Curr Anesthesiol Rep

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The concept of lung protection ventilation is based on a multimodal approach aimed at preventing the occurrence of ventilator-induced lung injury (VILI). The strategies used include (i) alveolar recruitment maneuvers in order to open up the closed lung units, (ii) application of optimal positive end-expiratory pressure adapted to the expiratory limb of the pressure-volume curve to prevent airway closure at small tidal volume ventilation, (iii) the use of small tidal volume ventilation to avoid overdistending alveoli and/or alveolar shear stress injury by the cyclical opening and closing of lung units, and lastly, (iv) the application of new ventilation modes that take into account the physiological concept of respiratory variability and in particular, neurally-adjusted ventilatory assist, which enhances both patient-ventilator synchrony and lung protective strategy.

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Inspiratory Muscle Unloading by Neurally Adjusted Ventilatory Assist During Maximal Inspiratory Efforts in Healthy Subjects

Cited by 152 publications

References 17 publications

Effect of Ventilatory Variability on Occurrence of Central Apneas

Effect of Ventilatory Variability on Occurrence of Central Apneas

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

Ventilating the Lungs Safely: What’s New for Infants and Children?

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