Neurally adjusted ventilatory assist in neonates with congenital diaphragmatic hernia

Kurland, Yonatan; Gurung, Kamal; Pallotto, Eugenia K.; Manimtim, Winston M; Feldman, Keith; Staggs, Vincent S.; Truog, William E.

doi:10.1038/s41372-021-01098-3

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…The utility of NAVA in newborn infants with structural diaphragmatic abnormalities has not been widely studied and since this ventilatory mode is dependent upon detection of neural diaphragmatic signals certain challenges may arise. In one study, after primary repair, infants with CDH placed on invasive NAVA were shown to have no differences in peak or resting electrical activity of the diaphragm during respiration compared to control infants with no underlying diaphragmatic abnormality, nor did they require higher levels of NAVA support (49). A recent case control study (n = 16) found no significant difference in the NAVA level (p = 0.286) used post-surgical repair in infants with CDH compared to those without CDH of similar age and weight at the time of study.…”

Section: Novel Ventilatory Modalities Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

“…A recent case control study (n = 16) found no significant difference in the NAVA level (p = 0.286) used post-surgical repair in infants with CDH compared to those without CDH of similar age and weight at the time of study. Furthermore, NAVA use in those with diaphragmatic hernia was associated with a reduction in ventilatory requirements and the need for sedative therapy (49). Two retrospective feasibility studies performed in infants with CDH following surgical repair showed that post-operative weaning of ventilation with both invasive (n = 10) and non-invasive (n = 7) NAVA to be successful (50,51).…”

Section: Novel Ventilatory Modalities Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

“…Two retrospective feasibility studies performed in infants with CDH following surgical repair showed that post-operative weaning of ventilation with both invasive (n = 10) and non-invasive (n = 7) NAVA to be successful (50,51). Additionally, the short-term outcomes of infants with CDH who have been placed on invasive NAVA post-surgery were assessed and NAVA was associated with a decrease in mean airway pressure (p < 0.001) and respiratory severity score (p < 0.001) at 72 h post initiation (p < 0.001) (49).…”

Section: Novel Ventilatory Modalities Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

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Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Williams

Greenough

2021

Front. Pediatr.

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Optimisation of respiratory support of infants with congenital diaphragmatic hernia (CDH) is critical. Infants with CDH often have severe lung hypoplasia and abnormal development of their pulmonary vasculature, leading to ventilation perfusion mismatch. It is vital that lung protective ventilation strategies are employed during both initial stabilisation and post-surgical repair to avoid ventilator induced lung damage and oxygen toxicity to prevent further impairment to an already diminished gas-exchanging environment. There is a lack of robust evidence for the routine use of surfactant therapy during initial resuscitation of infants with CDH and thus administration cannot be recommended outside clinical trials. Additionally, inhaled nitric oxide has been shown to have no benefit in reducing the mortality rates of infants with CDH. Other therapeutic agents which beneficially act on pulmonary hypertension are currently being assessed in infants with CDH in randomised multicentre trials. The role of novel ventilatory modalities such as closed loop automated oxygen control, liquid ventilation and heliox therapy may offer promise for infants with CDH, but the benefits need to be determined in appropriately designed clinical trials.

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Section: Novel Ventilatory Modalities Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

Section: Novel Ventilatory Modalities Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

Section: Novel Ventilatory Modalities Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

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Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Williams

Greenough

2021

Front. Pediatr.

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“…6 NAVA is already being used in newborns, especially premature ones, and has been shown to have many benefits: lower peak inspiratory pressure (PIP), lower work of breathing (WOB), better patient-ventilator interaction, and better gas exchange. [7][8][9][10][11][12][13] The use of NAVA was also associated with a reduction of sedation, 14 which probably impacts the hemodynamic status and risk of withdrawal in infants.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, it has been demonstrated that EAdi could be correctly detected in patients with CDH 15 and, moreover, that NAVA may decrease the inspiratory pressure but with a similar respiratory rate and minute ventilation. 14,16 Furthermore, it is reported that NAVA provides pressure support proportional to the patient's demand required and also that EAdi and respiratory effort are correlated 17,18 that have never been studied in infants with CDH.…”

Section: Introductionmentioning

confidence: 99%

Respiratory physiology during NAVA ventilation in neonates born with a congenital diaphragmatic hernia: The “NAVA‐diaph” pilot study

Dreyfus

Butin

Plaisant

et al. 2023

Pediatric Pulmonology

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Background Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that delivers synchronized ventilation, proportional to the electrical activity of the diaphragm (EAdi). Although it has been proposed in infants with a congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm. Aim To evaluate, in a pilot study, the relationship between the respiratory drive (EAdi) and the respiratory effort in neonates with CDH during the postsurgical period under either NAVA ventilation or conventional ventilation (CV). Methods This prospective physiological study included eight neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric, and transdiaphragmatic pressure, as well as clinical parameters, were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the postsurgical period. Results EAdi was detectable and there was a correlation between the ΔEAdi (maximal − minimal values) and the transdiaphragmatic pressure (r = 0.26, 95% confidence interval [CI] [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing. Conclusion Respiratory drive and effort were correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. EAdi can also be used to monitor the diaphragm for individualized support.

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