Noninvasive Neurally Adjusted Ventilatory Assist in Premature Infants Postextubation

Abstract

Neurally adjusted ventilatory assist (NAVA) has distinct advantages when used invasively compared with conventional ventilation techniques. Evidence supporting the use of noninvasive NAVA is less robust, especially in the very low birth weight (VLBW) population. To determine whether synchronized noninvasive ventilation via neurally adjusted ventilatory assist (NIV NAVA) supports ventilation postextubation in premature infants. A retrospective analysis of a cohort of twenty-four former VLBW (<1.5 kg) infants from July 2011 to October 2012. Decreased or unchanged capillary pCO after increasing NAVA support was used as a marker for adequately supported noninvasive ventilation. The Wilcoxon signed-rank test was used to compare pre- and post-NAVA intervention (α = 0.05). Ventilation improved after an increase in NIV NAVA level in 83% of the premature infants studied (20/24) with a decrease in median pCO by 5 mm Hg ( = 0.0001). NIV NAVA can provide synchronized postextubation ventilatory support as measured by decreased pCO in premature infants.

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

“…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 . Another study using NIV‐NAVA for very low‐birthweight infants noted a reduction in partial pressure of CO 2 in a capillary blood gas (pCO 2 ) . NIV‐NAVA is considered to have increased respiratory support ability compared with conventional modalities.…”

“…8 Another study using NIV-NAVA for very low-birthweight infants noted a reduction in partial pressure of CO 2 in a capillary blood gas (pCO 2 ). 9 NIV-NAVA is considered to have increased respiratory support ability compared with conventional modalities. Therefore, NIV-NAVA may be superior to other NIV for respiratory support after extubation in preterm infants.…”

Noninvasive neurally adjusted assisted ventilation as weaning mode in extremely preterm infants: a meta-analysis and systematic review

“…Conventional NIV prevents obstructive apnea by generating higher airway pressure, which can easily lead to lung injury and inadequate respiratory support. Conversely, NIV-NAVA continuously adjusts ventilation pressure and volume based on neural feedback from the respiratory center in preterm infants, and even reduces pCO 2 after extubation 20,43 . If apnea occurs NIV-NAVA can provide backup ventilation, shortening the apnea period and relieving hypoxia.…”

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

“…Yagui et al conducted a RCT (n = 123) comparing NIV-NAVA vs. NCPAP as the primary support in infants with BW <1500 g. There was no difference noted in the primary outcome of need for intubation prior to 72 hours of life, or for the secondary outcome of BPD, between the two groups [82]. Other small RCTs have shown that NIV-NAVA is as effective as NCPAP in preventing extubation failure, but large RCTs studying the outcome of BPD in extremely preterm infants are needed before NIV-NAVA can be routinely recommended [83][84][85][86][87].…”