Neurally Adjusted Ventilatory Assist in Newborns

Beck, Jennifer; Sinderby, Christer A.

doi:10.1016/j.clp.2021.07.007

Cited by 20 publications

(14 citation statements)

References 86 publications

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“…Supporting the infants’ own respiratory efforts with modes where both inspiration and expiration are synchronised, such as pressure support or NAVA, can improve patient comfort and facilitate weaning. However, to date, no differences have been shown in longer term clinical outcomes [135, 136].…”

Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12<sup>,</sup> 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

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Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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“…During ventilator care with NAVA, diaphragm electrical activity is monitored continuously and used to assess the level and pattern of respiration. Currently, the Edi signal is considered a respiratory vital sign that provides various pieces of information regarding breathing in patients with respiratory distress 4 , 7 , 8 . However, it is challenging to obtain reliable Edi signals, the electrical signals in the microvolt range, in an electrically noisy environment such as an intensive care unit with electrodes located in an electrically active esophagus, where peristalsis occurs, and next to the heart 28 .…”

Section: Discussionmentioning

confidence: 99%

“…Neurally adjusted ventilatory assist (NAVA) is a ventilatory support mode, in which the electrical activity of the diaphragm (Edi) is used to control the breathing cycle and support magnitude 4 . Edi is the most ideal signal that can be recorded noninvasively to represent the neural respiratory drive originating in the respiratory centers 5 .…”

Section: Introductionmentioning

confidence: 99%

Convolutional neural network-based respiration analysis of electrical activities of the diaphragm

Lee

2022

Sci Rep

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The electrical activity of the diaphragm (Edi) is considered a new respiratory vital sign for monitoring breathing patterns and efforts during ventilator care. However, the Edi signal contains irregular noise from complex causes, which makes reliable breathing analysis difficult. Deep learning was implemented to accurately detect the Edi signal peaks and analyze actual neural breathing in premature infants. Edi signals were collected from 17 premature infants born before gestational age less than 32 weeks, who received ventilatory support with a non-invasive neurally adjusted ventilatory assist. First, a local maximal detection method that over-detects candidate Edi peaks was used. Subsequently, a convolutional neural network-based deep learning was implemented to classify candidates into final Edi peaks. Our approach showed superior performance in all aspects of respiratory Edi peak detection and neural breathing analysis compared with the currently used recording technique in the ventilator. The method obtained a f1-score of 0.956 for the Edi peak detection performance and $${R}^{2}$$ R 2 value of 0.823 for respiratory rates based on the number of Edi peaks. The proposed technique can achieve a more reliable analysis of Edi signals, including evaluation of the respiration rate in premature infants.

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“…Newer technologies, such as neural adjusted ventilator assist (NAVA), which synchronizes NIPPV by detecting electrical discharges from diaphragmatic contractions, have been developed to circumvent this limitation. While there are many studies showing the benefits of NAVA in improving patient comfort, improving ventilator synchrony, and reducing apnea, a clear reduction in extubation failure compared to nonsynchronized NIPPV has yet to be demonstrated in clinical studies 7 …”

Section: Introductionmentioning

confidence: 99%

“…While there are many studies showing the benefits of NAVA in improving patient comfort, improving ventilator synchrony, and reducing apnea, a clear reduction in extubation failure compared to nonsynchronized NIPPV has yet to be demonstrated in clinical studies. 7 Given the difficulty in noninvasive synchronization, improvements in NCPAP that are not dependent on the respiratory cycle are particularly attractive. High-frequency nasal ventilation (HFNV) has been shown in in vitro mechanical and animal lung models to deliver distending alveolar pressure while improving CO 2 clearance.…”

Section: Introductionmentioning

confidence: 99%

Comparison of nasal intermittent positive pressure ventilation and bubble CPAP with an in‐line high‐frequency interrupter in a premature infant lung model

Rub

Sivieri

Abbasi

et al. 2022

Pediatric Pulmonology

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Introduction: Noninvasive ventilation has become a staple in the care of premature infants. However, failure rates continue to be high in this population. Modifications to noninvasive support, such as nasal intermittent positive pressure ventilation (NIPPV), are used clinically to reduce such failure. Previous in vitro studies have shown improved CO 2 clearance when superimposing high-frequency oscillations onto bubble continuous positive airway pressure (BCPAP).Objective: To compare the CO 2 clearance of NIPPV to BCPAP with an in-line highfrequency interrupter (HFI) in a premature infant lung model. Methods:A premature infant lung model was connected to either a Dräger VN500 for delivery of NIPPV or a BCPAP device with superimposed high-frequency oscillations generated by an in-line HFI. Change in end-tidal CO 2 (ETCO 2 ) and mean airway pressure at the simulated trachea were measured and compared for both noninvasive modalities.Results: Superimposing HF oscillations onto BCPAP with an in-line HFI resulted in improved CO 2 clearance relative to BCPAP alone for all tested oscillation frequencies at all CPAP levels (p < 0.001). NIPPV also resulted in improved CO 2 clearance relative to nasal CPAP (NCPAP) alone (p < 0.001). Among the tested settings, BCPAP with an in-line HFI resulted in decreased ETCO 2 relative to BCPAP ranging from -14% to -36%, while NIPPV resulted in decreased ETCO 2 relative to NCPAP ranging from -2% to -12%. Conclusion:Superimposing high-frequency oscillations onto BCPAP using a novel in-line HFI was found to be more effective at clearing CO 2 than NIPPV in a premature infant lung model.

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Neurally Adjusted Ventilatory Assist in Newborns

Cited by 20 publications

References 86 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

Convolutional neural network-based respiration analysis of electrical activities of the diaphragm

Comparison of nasal intermittent positive pressure ventilation and bubble CPAP with an in‐line high‐frequency interrupter in a premature infant lung model

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