Non-invasive neurally adjusted ventilatory assist in preterm infants: a randomised phase II crossover trial

Abstract

Registered with http://www.clinicaltrials.gov (NCT01877720).

Neural feedback is insufficient in preterm infants during neurally adjusted ventilatory assist

“…The ventilator data were downloaded from the ventilator, as we described previously . Considering the time for adjusting to the new setting, data recorded for the last 5 minutes of each NAVA level was used for the analysis.…”

“…Neurally adjusted ventilatory assist (NAVA), a technique that uses the electrical activity of the diaphragm (Edi) to control respiratory support and the NAVA level as an amplification factor that converts the Edi signal into a proportional pressure, has been developed and evaluated in many studies. Compared with conventional modes, NAVA in preterm infants improves patient‐ventilator synchrony, decreases delivered pressure or V T , and effectively reduces the work of breathing . In addition, unlike pressure‐ or volume‐targeted modes, the delivered pressure during NAVA is continually adjusted based on the Edi signal .…”

Non‐invasive neurally adjusted ventilatory assist versus nasal intermittent positive‐pressure ventilation in preterm infants born before 30 weeks’ gestation

“…Given that airway patency enables transmission of pressure to the distal airways during inspiration, synchronized delivery of ventilator cycles via Edi increases the efficacy of NIPPV . A small prospective cross‐over trial noted a reduction of asynchrony events and respiratory effort with NIV‐NAVA . In addition, one cross‐over study comparing NIV‐NAVA and NIPPV in preterm infants reported a reduction in peak inspiratory pressure (PIP), inspiratory O 2 fraction (FiO 2 ) and the frequency of desaturation with NIV‐NAVA .…”

Neurally adjusted ventilatory assist for infants under prolonged ventilation

“…In the NAVA group in this study, the patients received less frequent courses and doses of dexamethasone than the patients in the other group. No published evidence indicates that NAVA could accelerate weaning off the ventilator in preterm infants with severe BPD, but previous studies have shown that respiratory work and delivered peak pressure were lowered with NAVA while preserving respiratory effort in preterm infants . These advantages of NAVA might help preterm infants to be weaned off more easily while preventing further lung injury, but more studies are needed to verify the effect of NAVA on the ventilator weaning process in preterm infants.…”