scholarly journals Application of neurally adjusted ventilatory assist in ventilator weaning of infants ventilator weaning

2021 ◽  
Author(s):  
Shuna Xiao ◽  
Chengjiao Huang ◽  
Ying Cheng ◽  
Zhi Xia ◽  
Yong Li ◽  
...  
Keyword(s):  
Ventilator Weaning ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist

scholarly journals Neurally Adjusted Ventilatory Assist Is Associated with Greater Initial Extubation Success in Postoperative Congenital Heart Disease Patients when Compared to Conventional Mechanical Ventilation

2018 ◽  
Vol 07 (03) ◽  
pp. 147-158 ◽  
Author(s):  
Nasir Mushtaq ◽  
Kellie Brown ◽  
Vanette Littlefield ◽  
Roger Barton ◽  
Shawn Sood
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Median Duration ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Ventilator Weaning ◽  
Neurally Adjusted Ventilatory Assist ◽  
Initial Attempt ◽  
Ventilatory Assist

AbstractExtubation failure is associated with considerable morbidity and mortality in postoperative patients with congenital heart disease (CHD). The study purpose was to investigate initial extubation success utilizing neurally adjusted ventilatory assist (NAVA) compared with pressure-regulated volume controlled, synchronized intermittent mandatory ventilation with pressure support (SIMV-PRVC + PS) for ventilatory weaning in patients who required prolonged mechanical ventilation (MV). Also, total days on MV, inotropes, sedation, analgesia, and pediatric intensive care unit (PICU) length of stay (LOS) between both groups were compared. This was a non-randomized pilot study utilizing historical controls (SIMV-PRVC + PS; n = 40) compared with a prospective study population (NAVA; n = 35) in a Level I PICU and was implemented to help future trial designs. All patients (n = 75) required prolonged MV ≥96 hours due to their complex postoperative course. Ventilator weaning initiation and management was standardized between both groups. Ninety-seven percent of the NAVA group was successfully extubated on the initial attempt, while 80% were in the SIMV-PRVC + PS group (p = 0.0317). Patients placed on NAVA were eight times more likely to have successful initial extubation (odds ratio [OR]: 8.50, 95% confidence interval [CI]: 1.01, 71.82). The NAVA group demonstrated a shorter median duration on MV (9.0 vs. 11.0 days, p = 0.032), PICU LOS (9.0 vs. 13.5 days, p < 0.0001), and shorter median duration of days on dopamine (8.0 vs. 11.0 days, p = 0.0022), milrinone (9.0 vs. 12.0 days, p = 0.0002), midazolam (8.0 vs. 12.0 days, p < 0.0001), and fentanyl (9.0 vs. 12.5 days, p < 0.0001) compared with the SIMV-PRVC + PS group. NAVA compared with SIMV-PRVC + PS was associated with a greater initial extubation success rate. NAVA should be considered as a mechanical ventilator weaning strategy in postoperative congenital heart disease (CHD) patients and warrants further investigation.

scholarly journals Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey

2020 ◽  
Vol 7 (1) ◽  
pp. e000783
Author(s):  
Daniel Hadfield ◽  
Louise Rose ◽  
Fiona Reid ◽  
Victoria Cornelius ◽  
Nicholas Hart ◽  
...  
Keyword(s):  
Ventilator Weaning ◽  
Neurally Adjusted Ventilatory Assist ◽  
Clinical Implementation ◽  
Factors Affecting ◽  
Future Success ◽  
Ventilatory Assist ◽  
Technical Issues ◽  
Key Barrier ◽  
Critically Ill Adults ◽  
Clinician Support

BackgroundNeurally adjusted ventilatory assist (NAVA) involves an intricate interaction between patient, clinician and technology. To improve our understanding of this complex intervention and to inform future trials, this survey aimed to examine clinician attitudes, beliefs and barriers to NAVA use in critically ill adults within an institution with significant NAVA experience.MethodsA survey of nurses, doctors and physiotherapists in four Intensive Care Units (ICUs) of one UK university-affiliated hospital (75 NAVA equipped beds). The survey consisted of 39 mixed open and structured questions. The hospital had 8 years of NAVA experience prior to the survey.ResultsOf 466 distributed questionnaires, 301 (64.6%) were returned from 236 nurses (78.4%), 53 doctors (17.6%) and 12 physiotherapists (4.0%). Overall, 207/294 (70.4%) reported clinical experience. Most agreed that NAVA was safe (136/177, 76.8%) and clinically effective (99/176, 56.3%) and most perceived ‘improved synchrony’, ‘improved comfort’ and ‘monitoring the diaphragm’ to be key advantages of NAVA. ‘Technical issues’ (129/189, 68.3%) and ‘NAVA signal problems’ (94/180, 52.2%) were the most cited clinical disadvantage and cause of mode cross-over to Pressure Support Ventilation (PSV), respectively. Most perceived NAVA to be more difficult to use than PSV (105/174, 60.3%), although results were mixed when compared across different tasks. More participants preferred PSV to NAVA for initiating ventilator weaning (93/171 (54.4%) vs 29/171 (17.0%)). A key barrier to use and a consistent theme throughout was ‘low confidence’ in relation to NAVA use.ConclusionsIn addition to broad clinician support for NAVA, this survey describes technical concerns, low confidence and a perception of difficulty above that associated with PSV. In this context, high-quality training and usage algorithms are critically important to the design and of future trials, to clinician acceptance and to the clinical implementation and future success of NAVA.

scholarly journals Backup ventilation during neurally adjusted ventilatory assist in preterm infants

2021 ◽  
Author(s):  
Juyoung Lee ◽  
Vilhelmiina Parikka ◽  
Liisa Lehtonen ◽  
Hanna Soukka
Keyword(s):  
Preterm Infants ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist
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