NAVA—synchronized compared to nonsynchronized noninvasive ventilation for apnea, bradycardia, and desaturation events in VLBW infants

Abstract

Neurally adjusted ventilatory assistance (NAVA) can overcome technical difficulties with synchronizing noninvasive ventilation breaths with the patient, a modality often used in very low birthweight infants (VLBW) with apnea of prematurity (AOP). This study is a retrospective single‐center investigation into whether NAVA‐synchronized noninvasive (niNAVA) ventilation is better than nonsynchronized (nasal intermittent positive pressure ventilation [nIPPV]) for symptomatic apnea in VLBW infants. Nursing records of apnea, bradycardia, and/or desaturations were abstracted from the electronic medical records of 108 VLBW infants admitted to the neonatal intensive care unit (NICU) from 2015 to 2017 who received either of the two modalities, 61 epochs of niNAVA totaling 488 days and 103 epochs of nIPPV totaling 886.5 days. niNAVA was associated with a significant reduction in the number of isolated bradycardic events/day (0.48 ± 0.14 vs 1.35 ± 0.27; P = .019) and overall bradycardias/day (2.42 ± 0.47 vs 4.02 ± 0.53; P = .042) and there were more epochs with no events with niNAVA compared with nIPPV (23.0% vs 6.8%; P = .004). These results justify a prospective trial of NAVA‐synchronized noninvasive ventilation for VLBW infants with caffeine‐resistant AOP.

Nasal continuous positive airway pressure versus noninvasive NAVA in preterm neonates with apnea of prematurity: a pilot study with a novel approach

“…This pilot study showed the efficacy of this approach, in that NN0 decreased the number of CSE in premature neonates compared with using CPAP. Tabacura et al recently showed that noninvasive NAVA decreased the number of CSE compared with nonsynchronized noninvasive ventilation [8]. In this study, both modalities provide noninvasive ventilatory support, which has both short and long term associated risks [9].…”

Resultados de la ventilación asistida ajustada neuronalmente no invasiva y la presión positiva continua nasal en recién nacidos prematuros: revisión sistemática y metanálisis

“…14 El desafío actual en el campo del soporte respiratorio de los recién nacidos prematuros es proporcionar una carga adecuada de los músculos respiratorios y un intercambio de oxígeno con sincronización adecuada del trabajo respiratorio con presión de soporte apropiado. 15 Es frecuente el uso de VMI con intubación endotraqueal. Sin embargo, las complicaciones de la VMI, entre otras, lesiones pulmonares asociadas con el respirador, infecciones y DBP, pueden afectar seriamente el pronóstico a largo plazo de los recién nacidos prematuros, en especial aquellos muy prematuros.…”

Outcomes of noninvasive neurally adjusted ventilatory assist and nasal continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

“…14 The current challenge in the field of respiratory support for premature infants is to provide adequate respiratory muscle load and air exchange with adequate synchronization of respiratory work using appropriate pressure support. 15 IMV with endotracheal intubation are commonly used. However, IMV complications, including ventilator-associated lung injuries, infection, and bronchopulmonary dysplasia (BPD), can seriously affect the long-term prognosis of premature infants, especially very premature infants.…”