Neurally Adjusted Ventilatory Assist After Pediatric Cardiac Surgery: Clinical Experience and Impact on Ventilation Pressures

Crulli, Benjamin; Khebir, Mariam; Toledano, Baruch; Vobecky, Suzanne; Poirier, Nancy; Émériaud, Guillaume

doi:10.4187/respcare.05625

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…Recent studies confirmed the clinical feasibility and advantages of NAVA in pediatric patients after cardiac surgery [38,39] especially in patients with difficult weaning.…”

Section: Discussionmentioning

confidence: 79%

Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study

et al. 2020

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Background: Neurally adjusted ventilatory assist (NAVA) is an innovative mode for assisted ventilation that improves patient-ventilator interaction in children. The aim of this study was to assess the effects of patientventilator interaction comparing NAVA with pressure support ventilation (PSV) in patients difficult to wean from mechanical ventilation after moderate pediatric acute respiratory distress syndrome (PARDS). Methods: In this physiological crossover study, 12 patients admitted in the Pediatric Intensive Care Unit (PICU) with moderate PARDS failing up to 3 spontaneous breathing trials in less than 7 days, were enrolled. Patients underwent three study conditions lasting 1 h each: PSV1, NAVA and PSV2. Results: The Asynchrony Index (AI) was significantly reduced during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.001). During the NAVA trial, the inspiratory and expiratory trigger delays were significantly shorter compared to those obtained during PSV1 and PSV2 trials (Delay trinsp p < 0.001, Delay trexp p = 0.013). These results explain the significantly longer Time sync observed during the NAVA trial (p < 0.001). In terms of gas exchanges, PaO 2 value significantly improved in the NAVA trial with respect to the PSV trials (p < 0.02). The PaO 2 /FiO 2 ratio showed a significant improvement during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.004). Conclusions: In this specific PICU population, presenting difficulty in weaning after PARDS, NAVA was associated with a reduction of the AI and a significant improvement in oxygenation compared to PSV mode. Trial registration: ClinicalTrial.gov Identifier: NCT04360590 "Retrospectively registered".

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“…Recent studies confirmed the clinical feasibility and advantages of NAVA in pediatric patients after cardiac surgery [38,39] especially in patients with difficult weaning.…”

Section: Discussionmentioning

confidence: 79%

Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study

et al. 2020

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“…Several studies have compared NAVA to other conventional mechanical ventilator modes and have mainly been centered on the short-term outcomes, including respiratory support parameters, lung mechanics, Work of Breathing (WOB), duration of mechanical ventilation, sedation requirements, and EAdi [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. However, only a few studies have investigated the long-term outcomes of applying this novel technique in the preterm population.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Invasive Neonatal Respiratory Care: A Systematic Review of Invasive Neurally Adjusted Ventilatory Assist

Balasundaram,

Sakr

2024

Healthcare

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Background: Mechanical ventilation in preterm neonates aims for synchrony, preventing complications such as lung injury. Neurally Adjusted Ventilatory Assist (NAVA) is a unique mode relying on diaphragmatic electrical signals for synchronization. We conducted a review focusing on the long-term consequences of using invasive NAVA in neonates with a focus on bronchopulmonary dysplasia (BPD). Methods: A systematic review following PRISMA explored invasive NAVA in preterm neonates. Primary objectives compared NAVA to conventional ventilation, assessing BPD incidence, ventilation duration, length of stay, and adverse events. Secondary objectives analyzed ventilator parameters. Results: After screening 282 records, the review incorporated two randomized controlled trials for primary outcomes and seven trials for secondary outcomes, including two randomized crossovers, four prospective crossovers, and one retrospective study. NAVA showed reduced oxygen requirement at 28 days but no significant differences in oxygen need at 36 weeks postmenstrual age, total length of stay, or ventilator days. Substantial variations were not observed in adverse events. Ventilator variables favored NAVA, indicating decreased peak inspiratory pressure, tidal volume, work of breathing, and respiratory severity score. Conclusion: Our study found no significant reduction in BPD with NAVA despite short-term benefits. Future large-scale trials are essential to assess NAVA’s impact on long-term outcomes comprehensively.

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“…Most of these studies have shown that NAVA resulted in immediate beneficial effects on patients' ventilator settings and arterial blood gas data. However, these results are still controversial, and most of the studies have reported decreased peak inspiratory pressure (PIP) when changing from conventional ventilators to NAVA 1–14 . Some studies have reported a decrease in mean airway pressure in patients treated with NAVA; 1–4 however another study reported no change in mean airway pressure 5 .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, other studies have reported an increase in the respiratory rate in patients receiving NAVA, 3,8–10 whereas one study reported a decrease in respiratory rate 5 . Several studies have reported improvements in blood gases in patients who were treated with NAVA, 2,3,5,11,15 whereas other studies have reported no change 4,6,8,12,13,16 . Only few previous studies 14,17–18 have focused on late neonatal outcomes of preterm infants receiving NAVA, and the results were controversial with regard to the duration of invasive ventilation compared with conventional ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…However, these results are still controversial, and most of the studies have reported decreased peak inspiratory pressure (PIP) when changing from conventional ventilators to NAVA. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Some studies have reported a decrease in mean airway pressure in patients treated with NAVA; [1][2][3][4] however another study reported no change in mean airway pressure. 5 Some studies have reported decreased fraction of inspired oxygen (FiO 2 ) in patients receiving NAVA.…”

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confidence: 99%

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Neurally adjusted ventilatory assist for rapid weaning in preterm infants

Fang

Liao

et al. 2023

Pediatrics International

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BackgroundNeurally adjusted ventilatory assist (NAVA) is a new mode of subject‐triggered ventilation. Experience with the use of NAVA in preterm infants is limited. This study compared the effects of invasive mechanical ventilation with NAVA to conventional intermittent mandatory ventilation (CIMV) in terms of reducing the duration of oxygen requirement and invasive ventilator support in preterm infants.MethodsThis was a prospective study. We enrolled infants of less than 32 weeks’ gestation who were then randomized to receive either NAVA or CIMV support during hospitalization. We recorded and analyzed data on the maternal history during pregnancy, use of medications, neonatal data at admission, neonatal diseases, and respiratory support in the neonatal intensive care unit.ResultsThere were 26 preterm infants in the NAVA group and 27 preterm infants in the CIMV group. Significantly fewer infants in the NAVA group received supplemental oxygen at 28 days of age (12 [46%] vs. 21 [78%], p = 0.0365), and they required significantly fewer days of invasive ventilator support: 7.73 (± 2.39) vs. 17.26 (± 3.65), p = 0.0343.ConclusionsCompared with CIMV, NAVA appears to allow for more rapid weaning from invasive ventilation and decreases the incidence of bronchopulmonary dysplasia, especially in preterm infants with severe respiratory distress syndrome treated with surfactants.

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Neurally Adjusted Ventilatory Assist After Pediatric Cardiac Surgery: Clinical Experience and Impact on Ventilation Pressures

Abstract: NAVA could be used in pediatric subjects after cardiac surgery. The significant decrease in airway pressures observed after transition to NAVA could have a beneficial impact in this specific population, which should be investigated in future interventional studies.

Cited by 10 publications

References 27 publications

Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study

Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study

Optimizing Invasive Neonatal Respiratory Care: A Systematic Review of Invasive Neurally Adjusted Ventilatory Assist

Neurally adjusted ventilatory assist for rapid weaning in preterm infants

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