Neurally adjusted ventilatory assist for rapid weaning in preterm infants

Abstract

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.

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

“…Of the publications finally selected for analysis, only two studies (Fang et al and Kallio et al) addressed the primary objective, focusing on the incidence of BPD and adverse events associated with ventilators [ 56 , 57 ]. Fang et al and Kallio et al assessed oxygen requirement at 36 weeks postmenstrual age (PMA), but only Fang et al assessed oxygen requirement at 28 days of life.…”

“…In our comparative analysis, Fang et al [ 56 ] and Kallio et al [ 57 ] emerged as crucial contributors, each shedding a unique light on the use of invasive NAVA in neonatal ventilation. Fang et al [ 56 ] focused on infants with a GA < 32 weeks who were intubated during delivery room resuscitation and were enrolled within 24 h of birth.…”

“…In our comparative analysis, Fang et al [ 56 ] and Kallio et al [ 57 ] emerged as crucial contributors, each shedding a unique light on the use of invasive NAVA in neonatal ventilation. Fang et al [ 56 ] focused on infants with a GA < 32 weeks who were intubated during delivery room resuscitation and were enrolled within 24 h of birth. On the other hand, Kallio et al [ 57 ] encompassed a broader GA range (28 to 36 6/7 weeks) and concentrated on infants with RDS who were intubated for at least 4 h, with a median enrollment age of 9 days.…”

“…Although both trials used patient-triggered pressure-limited ventilation in the control group, they used two different ventilator modes. Kallio et al [ 57 ] used pressure-controlled ventilation (PCV), whereas Fang et al [ 56 ] used either synchronized intermittent mandatory ventilation (SIMV) or SIMV with pressure support (SIMV-PS). These modes support the infant’s breathing differently, but none have been shown to be superior except for in the duration of weaning, which tended to be shorter in infants supported by PCV [ 70 ].…”

Neurally adjusted ventilatory assist in preterm infants: A systematic review and meta‐analysis

“…This was summarized in a summary of findings table. Seven RCT's, five with crossover design and two with parallel group design, were included in this systematic review [14][15][16][17][18][19][20] (Figure 1). Table 1 presents the characteristics for each included study.…”