Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: Physiological evaluation*

Terzi, Nicolas; Pelieu, Iris; Guittet, Lydia; Ramakers, Michel; Seguin, Amélie; Daubin, Cédric; Charbonneau, P.; Cheyron, Damien du; Lofaso, Frédéric

doi:10.1097/ccm.0b013e3181eb3c51

Cited by 107 publications

(115 citation statements)

References 36 publications

(38 reference statements)

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“…These results are in line with studies in adults that all reported similar synchrony improvement with NAVA (5,11,12,20,21). In the pediatric population, no study has yet quantified the trigger delays and cycling-off delays during conventional ventilation and during NAVA, although two feasibility studies have demonstrated that during NAVA, at least two-thirds of assisted breaths were triggered by the neural signal (17,18).…”

Section: Nava In Infantssupporting

confidence: 75%

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Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

et al. 2012

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Background: Neurally adjusted ventilatory assist (NaVa) is a mode of ventilation controlled by the electrical activity of the diaphragm (edi). The aim was to evaluate patient-ventilator interaction in infants during NaVa as compared with conventional ventilation. Methods: Infants were successively ventilated with NaVa, pressure control ventilation (PcV), and pressure support ventilation (PsV). edi and ventilator pressure (Pvent) waveforms were compared and their variability was assessed by coefficients of variation. results: Ten patients (mean age 4.3 ± 2.4 mo and weight 5.9 ± 2.2 kg) were studied. In PcV and PsV, 4 ± 4.6% and 6.5 ± 7.7% of the neural efforts failed to trigger the ventilator. This did not occur during NaVa. Trigger delays were shorter with NaVa as compared with PcV and PsV (93 ± 20 ms vs. 193 ± 87 ms and 135 ± 29 ms). During PcV and PsV, the ventilator cycled off before the end of neural inspiration in 12 ± 13% and 21 ± 19% of the breaths (0 ± 0% during NaVa). During PcV and PsV, 24 ± 11% and 25 ± 9% of the neural breath cycle was asynchronous with the ventilator as compared with 11 ± 3% with NaVa. a large variability was observed for edi in all modes, which was transmitted into Pvent during NaVa (coefficient of variation: 24 ± 8%) and not in PcV (coefficient of variation 2 ± 1%) or PsV (2 ± 2%). conclusion: NaVa improves patient-ventilator interaction and delivers adequate ventilation with variable pressure in infants.c onventional modes of mechanical ventilation are clearly limited in their ability to provide synchrony between the patient and the assist delivered, as demonstrated repeatedly in adults (1,2) and more recently in children (3). Patientventilator asynchrony has been associated with poor clinical outcome (1,2,4). Despite the attempt to improve synchrony with "patient-triggered" modes such as pressure control ventilation (PCV) or pressure support ventilation (PSV), 25% of adult patients show more than 10% asynchrony with the ventilator (1,2,5). In pediatric patients, synchrony is particularly difficult to achieve because of the small tidal volumes, high respiratory rates, and weak airway flows and pressures. Ironically, during synchronized intermittent mandatory ventilation, more than half of the patient's breathing cycle is spent in asynchrony (3) with the ventilator.Besides the poor timing between the patient and the ventilator, patient-ventilator asynchrony also includes the inability of the ventilator to respond to patient demand and the natural breath-to-breath variability. Respiratory variability is a sign of a well functioning respiratory system (6). By definition, PCV and PSV deliver fixed levels of assist, thereby offering no possibility to respond to the patient's respiratory demand and variability.Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers assist in time and in proportion to the electrical activity of the diaphragm (Edi) on a breath-by-breath basis (7). Numerous studies have shown that NAVA efficiently unloads the respirat...

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Section: Nava In Infantssupporting

confidence: 75%

“…Numerous studies have shown that NAVA efficiently unloads the respiratory muscles (8,9) and delivers more synchronous ventilation than PSV (5,(9)(10)(11)(12). Furthermore, it was shown that ventilator pressures (during NAVA) follow the natural variability in breathing pattern (13)(14)(15).…”

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confidence: 99%

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

et al. 2012

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“…However, when delivering PS-NIV through a helmet, neural triggering has been shown to improve patient-ventilator synchrony compared to pneumatic triggering [11]. As neurally adjusted ventilatory assist (NAVA) [12] uses a neural signal (the diaphragm electrical activity, or EAdi, independent from airway pressure and flow signals), to trigger and cycle-off the ventilator as well as to adapt the amount of pressure delivered, and as NAVA improves patient-ventilator interaction during invasive ventilation [13][14][15][16], we hypothesized that NAVA could improve patient-ventilator synchrony during NIV. The purpose of this study was to test this hypothesis in adult intensive care patients requiring NIV because of acute respiratory failure or because of being at risk of respiratory failure after extubation [3].…”

Section: Introductionmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d ), the patient's neural inspiratory time (T in ), ventilator pressurization duration (T iv ), inspiratory time in excess (T iex ), number of asynchrony events per minute and asynchrony index (AI) were determined. Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO 2 and PaCO 2 were not different between ventilatory modes. Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

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“…11 Therefore, the pressure level is determined by the neural output of the patient's central respiratory command, which would be expected to prevent over-assistance. [12][13][14][15] Moreover, recent studies suggest that NAVA may allow a high level of breathing pattern variability. [16][17] Avoiding overassistance and delivering proportional assistance would be expected to limit apneas, although ventilation varies less during the night than during the day.…”

Section: See the Related Editorial On Page 884mentioning

confidence: 99%

Effect of Ventilatory Variability on Occurrence of Central Apneas

et al. 2013

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Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: Physiological evaluation*

Cited by 107 publications

References 36 publications

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Effect of Ventilatory Variability on Occurrence of Central Apneas

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