Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study

Abstract

Background: Neurally adjusted ventilatory assist (NAVA) is an innovative mode for assisted ventilation that improves patient-ventilator interaction in children. The aim of this study was to assess the effects of patientventilator interaction comparing NAVA with pressure support ventilation (PSV) in patients difficult to wean from mechanical ventilation after moderate pediatric acute respiratory distress syndrome (PARDS). Methods: In this physiological crossover study, 12 patients admitted in the Pediatric Intensive Care Unit (PICU) with moderate PARDS failing up to 3 spontaneous breathing trials in less than 7 days, were enrolled. Patients underwent three study conditions lasting 1 h each: PSV1, NAVA and PSV2. Results: The Asynchrony Index (AI) was significantly reduced during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.001). During the NAVA trial, the inspiratory and expiratory trigger delays were significantly shorter compared to those obtained during PSV1 and PSV2 trials (Delay trinsp p < 0.001, Delay trexp p = 0.013). These results explain the significantly longer Time sync observed during the NAVA trial (p < 0.001). In terms of gas exchanges, PaO 2 value significantly improved in the NAVA trial with respect to the PSV trials (p < 0.02). The PaO 2 /FiO 2 ratio showed a significant improvement during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.004). Conclusions: In this specific PICU population, presenting difficulty in weaning after PARDS, NAVA was associated with a reduction of the AI and a significant improvement in oxygenation compared to PSV mode. Trial registration: ClinicalTrial.gov Identifier: NCT04360590 "Retrospectively registered".

Resultados de la ventilación asistida ajustada neuronalmente no invasiva y la presión positiva continua nasal en recién nacidos prematuros: revisión sistemática y metanálisis

“…[20][21] En un estudio fisiológico de grupos cruzados q u e e x p l o r ó l o s e f e c t o s d e l a N A V A e n comparación con la ventilación con presión de soporte en una población pediátrica con síndrome de dificultad respiratoria aguda moderada y dificultad para la desconexión del respirador se observó que la NAVA redujo significativamente el índice de falta de sincronización, mejoró la sincronía entre el paciente y el respirador y mantuvo la estabilidad hemodinámica. 22 Sin embargo, debido a la inmadurez del sistema nervioso y del centro respiratorio de los recién nacidos prematuros, pueden ocurrir episodios múltiples de apnea, cuya incidencia está estrechamente relacionada con la madurez. En otro estudio, se sugirió que la NAVA no presentaba ninguna ventaja obvia en los recién nacidos prematuros y que no puede usarse en reemplazo de la NCPAP.…”

Outcomes of noninvasive neurally adjusted ventilatory assist and nasal continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

“…[20][21] A physiological crossover study exploring the effects of NAVA compared to pressure support ventilation in a pediatric population with moderate acute respiratory distress syndrome presenting difficult weaning from mechanical ventilation found that NAVA significantly reduced the asynchrony index, improved patientventilator synchrony, maintaining hemodynamic stability. 22 However, due to the immature development of the nervous system and respiratory center of premature infants, multiple apneas may occur and the incidence is closely related to maturity. Another study suggested that NAVA has no obvious advantage for premature infants and cannot be used as a substitute for NCPAP.…”