Physiologic Response to Changing Positive End-Expiratory Pressure During Neurally Adjusted Ventilatory Assist in Sedated, Critically Ill Adults

Passath, Christina; Takala, Jukka; Tuchscherer, Daniel; Jakob, Stephan M.; Sinderby, Christer A.; Brander, Lukas

doi:10.1378/chest.10-0286

Cited by 55 publications

(77 citation statements)

References 42 publications

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“…The effect of Vt and ʃEadi related to increase in NAVA level have been extensively described by Passath et al [10]. Based on the results, we can assume that increasing NAVA level will result in a consecutive decrease in Eadi and in a small and only initial increase in Vt. As a consequence, we can assume that with increased NAVA level, Vt/ʃEadi ratio will also increase, but this point must be formally explored in future studies to test this hypothesis.…”

Section: Limitationssupporting

confidence: 56%

“…Vt is the tidal volume given to patients and ʃEadi is defined as an expression for patient's ventilatory demand. The ratio of Vt/ʃEadi is previously defined as Neuroventilatory efficiency, by Passath et al [10], and this the ratio also carries the information of ventilator supply over patients demand (A form of Patients-ventilator interaction). …”

Section: Matching Analysis -Range90 Of Supply Over Demandmentioning

confidence: 99%

See 1 more Smart Citation

NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand

Moorhead

Piquilloud²,

Lambermont

et al. 2012

J Clin Monit Comput

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Section: Limitationssupporting

confidence: 56%

Section: Matching Analysis -Range90 Of Supply Over Demandmentioning

confidence: 99%

NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand

Moorhead

Piquilloud²,

Lambermont

et al. 2012

J Clin Monit Comput

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show abstract

“…The effect of PEEP titration during NAVA was recently reported by Passath et al, 66 in a series of 20 patients, only one of whom had acute respiratory distress syndrome. Passath et al first adjusted NAVA to an adequate level, as previously defined, 56 then titrated the PEEP up and down and evaluated the effect on respiratory drive.…”

Section: Critically Ill Adultsmentioning

confidence: 66%

“…[60][61][62][63][64][65][66] In a series of 15 adult critically ill patients, all with a P aO 2 /F IO 2 Ͻ 300 mm Hg, Brander et al determined an "adequate" level of NAVA. 60 Adequate NAVA was identified by the slope change in airway pressure and tidal volume curves as NAVA was increased.…”

Section: Critically Ill Adultsmentioning

confidence: 99%

Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist

Kacmarek

2011

Respir Care

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Patient-ventilator synchrony is a common problem with all patients actively triggering the mechanical ventilator. In many cases synchrony can be improved by vigilant adjustments by the managing clinician. However, in most institutions clinicians are not able to spend the time necessary to ensure synchrony in all patients. Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) were both developed to improve patient-ventilator synchrony by proportionally unloading ventilatory effort and turning control of the ventilatory pattern over to the patient. This paper discusses PAV's and NAVA's theory of operation, general process of application, and the supporting literature.

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“…However, this must be balanced against the potential benefits of PEEP in patients with respiratory failure (Amato et al, 1998, Haitsma andLachmann, 2006). Both impairment of the diaphragmatic length-tension relationship associated with excessive PEEP, and the worsening of respiratory mechanics seen with inadequate PEEP, may lead to an increase in respiratory drive and neuroventilatory efficiency (Passath et al, 2010). Recent work investigating the effects of PEEP in patients receiving Neurally Adjusted Ventilatory Assist confirms that increasing PEEP reduces respiratory drive, but also suggests that patients are able to adapt their neuroventilatory efficiency over a wide range of applied PEEP levels.…”

Section: Muscle Length-tension Changesmentioning

confidence: 99%

Inspiratory muscle training to enhance recovery from invasive mechanical ventilation

Bissett¹

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Inspiratory muscle weakness is a consequence of prolonged mechanical ventilation and may contribute to the residual physical disability which has been observed in intensive care survivors. Inspiratory muscle weakness is associated with duration of mechanical ventilation, with those ventilated for 7 days or longer most at risk of developing both strength and endurance deficits.Specific resistance training of the inspiratory muscles (inspiratory muscle training) improves inspiratory muscle strength and endurance in normal people, athletes and patients with a wide variety of underlying pathologies. Mechanisms of improvement include proliferation of both Type 1 and Type 2 inspiratory muscle fibres, enhanced metabolism resulting in reduced lactate production, attenuation of a fatigue-induced metaboreflex, adaptations to neural pathways and modulation of the perception of dyspnoea.Furthermore, inspiratory muscle training enhances exercise tolerance and reduces dyspnoea in both patients and athletes, while improving quality of life for patients with chronic lung or heart disease.There is a lack of evidence for inspiratory muscle training in intensive care patients, despite the potential benefits of training in this group. This project explores the feasibility, safety and efficacy of inspiratory muscle training in intensive care patients who have been mechanically ventilated for 7 days or longer, as this subset of patients is most likely to demonstrate inspiratory muscle weakness and therefore benefit from specific training. This project includes patient-centred outcome measures, as most studies of inspiratory muscle training to date have focused solely on impairments, rather than the patient experiences of quality of life, physical function or dyspnoea.Study 1 establishes the safety and feasibility of high-intensity interval-based inspiratory muscle training in selected ventilator-dependent patients. Across 195 inspiratory muscle training sessions, there were no adverse events recorded during or immediately following the treatment. No significant changes were observed in heart rate, blood pressure, respiratory rate or oxygen saturation. Furthermore, mean training pressures increased by a mean difference of 18.6 cm H2O across the 10 patients studied. Thus Study 1 confirms that inspiratory muscle training is safe in selected ventilator-dependent patients.-ii- (mean difference 11%), but not endurance, while quality of life improved more in the experimental group than the control (mean difference 12%). Improvements in physical function and dyspnoea were equivalent. Thus 2 weeks of inspiratory muscle training improves inspiratory muscle strength and quality of life in the post-weaning period.-iiiFinally, Study 5 is a protocol for a randomised trial of inspiratory muscle training performed by patients while mechanically-ventilated. Study 5 measures the impact of inspiratory muscle training on duration of mechanical ventilation, as well as residual inspiratory muscle strength and endurance, quality of life, physical f...

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Physiologic Response to Changing Positive End-Expiratory Pressure During Neurally Adjusted Ventilatory Assist in Sedated, Critically Ill Adults

Cited by 55 publications

References 42 publications

NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand

NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand

Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist

Inspiratory muscle training to enhance recovery from invasive mechanical ventilation

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