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

Hunt, Katie; Dassios, Theodore; Greenough, Anne

doi:10.1007/s00431-020-03584-w

Cited by 20 publications

(21 citation statements)

References 29 publications

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“… 107 Hunt et al similarly compared NAVA and proportional assist ventilation in 18 infants born <32 weeks of gestation with evolving or established BPD and reported that there was no significant difference in the mean oxygenation index between the two modes, but the mean alveolar–arterial gradient was better on NAVA. 108 NAVA can also be used as a non-invasive modality. Forty infants with a gestational age of 28–36 weeks requiring CPAP for respiratory distress were randomised to non-invasive NAVA or CPAP and the authors reported that, after 12 h of treatment, the mean FiO 2 requirement and need for invasive ventilation did not differ between the two groups.…”

Section: Neurally Adjusted Ventilator Assist (Nava)mentioning

confidence: 99%

Respiratory muscle function in the newborn: a narrative review

2021

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Our aim was to summarise the current evidence and methods used to assess respiratory muscle function in the newborn, focusing on current and future potential clinical applications. The respiratory muscles undertake the work of breathing and consist mainly of the diaphragm, which in the newborn is prone to dysfunction due to lower muscle mass, flattened shape and decreased content of fatigue-resistant muscle fibres. Premature infants are prone to diaphragmatic dysfunction due to limited reserves and limited capacity to generate force and avoid fatigue. Methods to assess the respiratory muscles in the newborn include electromyography, maximal respiratory pressures, assessment for thoraco-abdominal asynchrony and composite indices, such as the pressure–time product and the tension time index. Recently, there has been significant interest and a growing body of research in assessing respiratory muscle function using bedside ultrasonography. Neurally adjusted ventilator assist is a novel ventilation mode, where the level of the respiratory support is determined by the diaphragmatic electrical activity. Prolonged mechanical ventilation, hypercapnia and hypoxia, congenital anomalies and systemic or respiratory infection can negatively impact respiratory muscle function in the newborn, while caffeine and synchronised or volume-targeted ventilation have a positive effect on respiratory muscle function compared to conventional, non-triggered or pressure-limited ventilation, respectively. Impact Respiratory muscle function is impaired in prematurely born neonates and infants with congenital anomalies, such as congenital diaphragmatic hernia. Respiratory muscle function is negatively affected by prolonged ventilation and infection and positively affected by caffeine and synchronised compared to non-synchronised ventilation modes. Point-of-care diaphragmatic ultrasound and neurally adjusted ventilator assist are recent diagnostic and therapeutic technological developments with significant clinical applicability.

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Section: Neurally Adjusted Ventilator Assist (Nava)mentioning

confidence: 99%

Respiratory muscle function in the newborn: a narrative review

2021

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“…Proportional assist ventilation (PAV) synchronizes pressure support with the patient's respiratory demand throughout the respiratory cycle. In a recent study, both PAV and NAVA were found to improve oxygenation when compared to conventional ventilation [29]. Still, important questions remain regarding the optimal level of support required for different neonatal respiratory problems.…”

Section: Synchronized Modes Of Imvmentioning

confidence: 99%

The Intertemporal Role of Respiratory Support in Improving Neonatal Outcomes: A Narrative Review

et al. 2021

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Defining improvements in healthcare can be challenging due to the need to assess multiple outcomes and measures. In neonates, although progress in respiratory support has been a key factor in improving survival, the same degree of improvement has not been documented in certain outcomes, such as bronchopulmonary dysplasia. By exploring the evolution of neonatal respiratory care over the last 60 years, this review highlights not only the scientific advances that occurred with the application of invasive mechanical ventilation but also the weakness of the existing knowledge. The contributing role of non-invasive ventilation and less-invasive surfactant administration methods as well as of certain pharmacological therapies is also discussed. Moreover, we analyze the cost–benefit of neonatal care-respiratory support and present future challenges and perspectives.

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“…Even though extensively studied in animal models of different lung injuries, 22,23 the clinical application of PAV has only been evaluated in small cohorts of neonates during short periods focusing mainly on feasibility, 24,25 and less in prospective randomized controlled trials (RCTs). Clinical studies have shown short‐term benefits in neonates with acute respiratory distress syndrome (RDS) and evolving bronchopulmonary dysplasia (BPD) in terms of maintaining stable gas exchange and lower oxygen index at lower mean airway pressures (MAPs), compared to other modes of patient triggered ventilations 24–28 (Table 2), but no long term RCTs have been performed to evaluate outcomes such as the development of BPD and/or duration of mechanical ventilation. Both the facilitated spontaneous breathing and the lower MAP without compromised oxygenation or ventilation, suggest the possibility of using PAV to minimize ventilator induced lung injury in the early phase of life in extremely preterm infants, and later during the weaning of long term mechanically ventilated infants, applications that need future large controlled studies.…”

Section: Proportional Assist Ventilationmentioning

confidence: 99%

“…Additionally, periods of apnea and low EAdi activity were reported which necessitated back up ventilation and/or switching to other modes of ventilation in some infants 46 . In multiple small prospective cross‐over studies in infants with RDS or evolving BPD, NAVA has been shown to reduce the PIP, the fraction of inspired oxygen, and the work of breathing compared with other patient‐triggered ventilatory modes 28,46–55 (Table 4). In a multi‐center review of current clinical practice, NAVA was successful as a weaning mode of ventilation in infants with severe BPD 67% of the time 56 …”

Section: Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants

Sindelar

McKinney

Wallström

et al. 2021

Pediatric Pulmonology

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Different types of patient triggered ventilator modes have become the mainstay of ventilation in term and preterm newborn infants. Maintaining spontaneous breathing has allowed for earlier weaning and the additive effects of respiratory efforts combined with pre‐set mechanical inflations have reduced mean airway pressures, both of which are important components in trying to avoid lung injury and promote normal lung development. New sophisticated modes of assisted ventilation have been developed during the last decades where the control of ventilator support is turned over to the patient. The ventilator detects the respiratory effort and adjusts ventilatory assistance proportionally to each phase of the respiratory cycle, thus enabling the patient to have full control of the start, the duration and the amount of ventilatory assistance. In this paper we will review the literature on the ventilatory modes of proportional assist ventilation and neurally adjusted ventilatory assistance, examine the different ways the signals are analyzed, propose future studies, and suggest ways to apply these modes in the clinical environment.

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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

Cited by 20 publications

References 29 publications

Respiratory muscle function in the newborn: a narrative review

Respiratory muscle function in the newborn: a narrative review

The Intertemporal Role of Respiratory Support in Improving Neonatal Outcomes: A Narrative Review

Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants

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