Is noninvasive neurally adjusted ventilatory assistance (NIV-NAVA) an alternative to NCPAP in preventing extubation failure in preterm infants?

Yagui, Ana Cristina Zanon; Gonçalves, Paula A; S, Murakami; Santos, Alba; Zacharias, Romy Schmidt Brock; Rebello, Celso Moura

doi:10.1080/14767058.2019.1697669

Cited by 21 publications

(9 citation statements)

References 34 publications

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“…The apnea detection time used to trigger back‐up ventilation was 10 s and a shorter period may have been more appropriate in these patients 36 . Although some small randomized controlled trials 9,37 and retrospective studies 38–40 reported reduced respiratory failure rates with NIV‐NAVA, there is a lack of good evidence to determine its superiority over other modes of noninvasive support 41 . Thus, until larger randomized trials are conducted, some caution should be exercised when integrating NIV‐NAVA into the care of extremely preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory effects of NIV‐NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: A randomized crossover trial

Latremouille

Bhuller

Shalish

et al. 2021

Pediatric Pulmonology

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Objective Investigate the cardiorespiratory effects of noninvasive neurally adjusted ventilatory assist (NIV‐NAVA), nonsynchronized nasal intermittent positive pressure ventilation (NIPPV), and nasal continuous positive airway pressure (NCPAP) shortly after extubation. Hypothesis Types of noninvasive pressure support and the presence of synchronization may affect cardiorespiratory parameters. Study Design Randomized crossover trial. Patient–Subject Selection Infants with birth weight (BW) 1250 g or under, undergoing their first planned extubation were randomly assigned to all three modes using a computer‐generated sequence. Methodology Electrocardiogram and electrical activity of the diaphragm (Edi) were recorded for 30 min on each mode. Analysis of heart rate variability (HRV), diaphragmatic activity (Edi area, breath area, amplitude, inspiratory and expiratory times), and respiratory variability were compared between modes. Results Twenty‐three infants had full data recordings and analysis: Median (IQR) gestational age = 25.9 weeks (25.2–26.4), BW = 760 g (595–900), and postnatal age 7 (4–19) days. There were no differences in HRV between modes. A significantly reduced Edi area and breath amplitude, and increased coefficient of variation (CV) of breath amplitude were observed during NIV‐NAVA and NIPPV compared to NCPAP. A higher proportion of assisted breaths (99% vs. 51%; p < .001) provided a higher mean airway pressure (MAP; 9.4 vs. 8.2 cmH2O; p = .002) with lower peak inflation pressures (PIPs; 14 vs. 16 cmH2O; p < .001) during NIV‐NAVA compared to NIPPV. Conclusions NIV‐NAVA and NIPPV applied shortly after extubation were associated with lower respiratory efforts and higher respiratory variability. These effects were more evident for NIV‐NAVA where optimal patient–ventilator synchronization provided a higher MAP with lower PIPs.

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Section: Discussionmentioning

confidence: 99%

Cardiorespiratory effects of NIV‐NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: A randomized crossover trial

Latremouille

Bhuller

Shalish

et al. 2021

Pediatric Pulmonology

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“…Stein et al in a retrospective study reported that in preterm infants managed on NAVA mode maintained better blood (89). Studies using NIV-NAVA mode in extremely preterm infants are limited with some of the recent studies showing promising results (Table 6) (16,(90)(91)(92)(93)(94)(95). Larger trials are needed to determine if NIV-NAVA is a better mode to provide sNIPPV to prevent BPD.…”

Section: Use Of Niv Nava In Nicumentioning

confidence: 99%

A Review on Non-invasive Respiratory Support for Management of Respiratory Distress in Extremely Preterm Infants

et al. 2020

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“…Even though no difference was observed between NIV‐NAVA and nCPAP with respect to need of intubation in both these studies (35 vs. 50%, Kallio et al; 20.3 vs. 15.6%, Yagui et al), a longer duration of mechanical ventilation in the NIV‐NAVA group was reported in the study by Kallio et al, whereas a shorter duration could be observed by Yagui et al, possibly explained by surfactant being administered non‐invasively and earlier in the latter study but contradicted by the fact that NIV‐NAVA combined with early surfactant did not result in later intubation compared to nasal CPAP with early surfactant in that study 57,58 (Table 4). Using NIV‐NAVA after extubation seems more promising where two small retrospective studies observed more successful weaning with NIV‐NAVA than nCPAP, measured as failure within 72 h of extubation 59,60 . A Cochrane review from 2020 evaluating the safety and effectiveness of NIV‐NAVA versus NIPPV included only two studies and found that there was not enough evidence to draw conclusions on their primary outcomes of safety and efficacy 61 .…”

Section: Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants

Sindelar

McKinney

Wallström

et al. 2021

Pediatric Pulmonology

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Different types of patient triggered ventilator modes have become the mainstay of ventilation in term and preterm newborn infants. Maintaining spontaneous breathing has allowed for earlier weaning and the additive effects of respiratory efforts combined with pre‐set mechanical inflations have reduced mean airway pressures, both of which are important components in trying to avoid lung injury and promote normal lung development. New sophisticated modes of assisted ventilation have been developed during the last decades where the control of ventilator support is turned over to the patient. The ventilator detects the respiratory effort and adjusts ventilatory assistance proportionally to each phase of the respiratory cycle, thus enabling the patient to have full control of the start, the duration and the amount of ventilatory assistance. In this paper we will review the literature on the ventilatory modes of proportional assist ventilation and neurally adjusted ventilatory assistance, examine the different ways the signals are analyzed, propose future studies, and suggest ways to apply these modes in the clinical environment.

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Is noninvasive neurally adjusted ventilatory assistance (NIV-NAVA) an alternative to NCPAP in preventing extubation failure in preterm infants?

Cited by 21 publications

References 34 publications

Cardiorespiratory effects of NIV‐NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: A randomized crossover trial

Cardiorespiratory effects of NIV‐NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: A randomized crossover trial

A Review on Non-invasive Respiratory Support for Management of Respiratory Distress in Extremely Preterm Infants

Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants

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