Neurally adjusted ventilatory assist (NAVA) in preterm newborn infants with respiratory distress syndrome—a randomized controlled trial

Kallio, Merja; Koskela, Ulla; Peltoniemi, Outi; Kontiokari, Tero; Pokka, Tytti; Suo‐Palosaari, Maria; Saarela, Timo

doi:10.1007/s00431-016-2758-y

Cited by 58 publications

(57 citation statements)

References 30 publications

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“…There was no significant difference in the primary outcome of the duration of ventilation (35 versus 26 h, p = 0.21). There was also no difference in the incidence of BPD, but the study was not powered to detect this [15].…”

Section: Discussionmentioning

confidence: 94%

“…The results of short-term studies [5][6][7][8][9][10][11][12][13][14][15] suggest that both PAV and NAVA improved oxygenation and were associated with lower airway pressures compared to conventional or other triggered modes of ventilation in prematurely born infants with evolving BPD, otherwise known as chronic pulmonary insufficiency of prematurity (CPIP) [16]. There are no studies in that population comparing PAV and NAVA, and hence the aim of this study was to compare the effect of PAV and NAVA on the oxygenation index in infants with evolving or established BPD.…”

Section: Introductionmentioning

confidence: 99%

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Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

2020

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Both proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) provide pressure support synchronised throughout the respiratory cycle proportional to the patient's respiratory demand. Our aim was to compare the effect of these two modes on oxygenation in infants with evolving or established bronchopulmonary dysplasia. Two-hour periods of PAVand NAVA were delivered in random order to 18 infants born less than 32 weeks of gestation. Quasi oxygenation indices ("OI") and alveolararterial ("A-a") oxygen gradients at the end of each period on PAV, NAVA and baseline ventilation were calculated using capillary blood samples. The mean "OI" was not significantly different on PAV compared to NAVA (7.8 (standard deviation (SD) 3.2) versus 8.1 (SD 3.4), respectively, p = 0.70, but lower on both than on baseline ventilation (mean baseline "OI" 11.0 (SD 5.0)), p = 0.002, 0.004, respectively). The "A-a" oxygen gradient was higher on PAV and baseline ventilation than on NAVA (20.8 (SD 12.3) and 22.9 (SD 11.8) versus 18.5 (SD 10.8) kPa, p = 0.015, < 0.001, respectively). Conclusion: Both NAVA and PAV improved oxygenation compared to conventional ventilation. There was no significant difference in the mean "OI" between the two modes, but the mean "A-a" gradient was better on NAVA. What is Known: • Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) can improve the oxygenation index (OI) in prematurely born infants. • Both PAV and NAVA can provide support proportional to respiratory drive or demand throughout the respiratory cycle. What is New: • In infants with evolving or established BPD, using capillary blood samples, both PAV and NAVA compared to baseline ventilation resulted in improvement in the "OI", but there was no significant difference in the "OI" on PAV compared to NAVA. • The "alveolar-arterial" oxygen gradient was better on NAVA compared to PAV.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

2020

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“…Most of these studies examined the very short-term effects of NAVA. Some reported improved patient-ventilator interaction, or decreased PIP within 24 h of NAVA use (10,14). Oda et al reported NAVA use in 14 extremely low birth weight infants.…”

Section: Discussionmentioning

confidence: 99%

Application of Neurally Adjusted Ventilatory Assist in Premature Neonates Less Than 1,500 Grams With Established or Evolving Bronchopulmonary Dysplasia

Xiao

Feng

et al. 2020

Front. Pediatr.

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Background: Very low birth weight premature (VLBW) infants with bronchopulmonary dysplasia (BPD) often need prolonged respiratory support, which is associated with worse outcomes. The application of neurally adjusted ventilatory assist ventilation (NAVA) in infants with BPD has rarely been reported. This study investigated whether NAVA is safe and can reduce the duration respiratory support in VLBW premature infants with established or evolving BPD. Methods: This retrospective matched-cohort study included patients admitted to our NICU between April 2017 to April 2019 who were born at <32 weeks' gestation with birthweight of <1,500 g. The study groups (NAVA group) were infants who received NAVA ventilation as a sequel mode of ventilation after at least 2 weeks of traditional respiratory support after birth. The control group were preterm infants who required traditional respiratory support beyond first 2 weeks of life and were closely matched to the NAVA patients by gestational age and birthweight. The primary outcome was to compare the total duration of respiratory support between the NAVA group and the control group. The secondary outcomes were comparisons of duration of invasive and non-invasive support, oxygen therapy, length of stay, severity of BPD, weight gain and sedation need between the groups. Results: There were no significant differences between NAVA group and control group in the primary and most of the secondary outcomes (all P > 0.05). However, NAVA was well tolerated and there was a decrease in the need of sedation (p = 0.012) after switching to NAVA. Conclusion: NAVA, when used as a sequel mode of ventilation, in premature neonates <1,500 g with evolving or established BPD showed a similar effect compared to conventional ventilation in respiratory outcomes. NAVA can be safely used in this patient population and potentially can decrease the need of sedation.

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“…Invasive NAVA has been used in neonates, and studies have shown that it is a safe and feasible mode of synchronized ventilation, improves patient‐ventilator interaction, provides lower PIP and may improve patient comfort . NIV‐NAVA is a relatively new ventilatory strategy .…”

Section: Discussionmentioning

confidence: 99%

Nasal continuous positive airway pressure (NCPAP) or noninvasive neurally adjusted ventilatory assist (NIV‐NAVA) for preterm infants with respiratory distress after birth: A randomized controlled trial

Yagui

Meneses

Zólio

et al. 2019

Pediatric Pulmonology

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Objectives To compare rates of treatment failure between the use of nasal continuous positive airway pressure (NCPAP) and noninvasive neurally adjusted ventilatory assist (NIV‐NAVA) in infants with respiratory distress after birth. Methods A randomized, unblinded, double‐center trial was conducted in infants with birth weights (BWs) less than or equal to 1500 g and respiratory distress receiving noninvasive respiratory support for less than or equal to 48 hours of life; some infants were initially treated with minimally invasive surfactant therapy as the standard of care. Primary outcome: need for endotracheal intubation with use of mechanical ventilation (MV) at less than or equal to 72 hours of life using prespecified failure criteria. Secondary outcomes: use of surfactant, duration of noninvasive support, duration of MV, bronchopulmonary dysplasia (BPD) and death. Results A total of 123 infants were included (NCPAP group = 64 and NIV‐NAVA group = 59). Population characteristics were similar between groups. No difference in the primary outcome was observed: NCPAP = 10 (15.6%) and NIV‐NAVA = 12 (20.3%), P = .65. Groups were also similar in the use of surfactant (19 vs 17), duration of noninvasive support (147 ± 181 hours vs 127 ± 137 hours), BPD incidence and death. However, duration of MV was significantly longer in NCPAP group (95.6 ± 45.8 hours vs 28.25 ± 34.1 hour), P = .01. Conclusion In infants with respiratory distress after birth, no differences in treatment failures were observed between NIV‐NAVA and NCPAP. These results require further evaluation in a larger study.

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Neurally adjusted ventilatory assist (NAVA) in preterm newborn infants with respiratory distress syndrome—a randomized controlled trial

Cited by 58 publications

References 30 publications

Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia

Application of Neurally Adjusted Ventilatory Assist in Premature Neonates Less Than 1,500 Grams With Established or Evolving Bronchopulmonary Dysplasia

Nasal continuous positive airway pressure (NCPAP) or noninvasive neurally adjusted ventilatory assist (NIV‐NAVA) for preterm infants with respiratory distress after birth: A randomized controlled trial

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