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

scholarly journals Feasibility and physiological effects of noninvasive neurally adjusted ventilatory assist in preterm infants

2017 ◽  
Vol 82 (4) ◽  
pp. 650-657 ◽  
Author(s):  
Christopher K Gibu ◽  
Phillip Y Cheng ◽  
Raymond J Ward ◽  
Benjamin Castro ◽  
Gregory P Heldt
Keyword(s):  
Preterm Infants ◽  
Neurally Adjusted Ventilatory Assist ◽  
Physiological Effects ◽  
Ventilatory Assist

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):  
Respiratory Rate ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Clinical Deterioration ◽  
Neurally Adjusted Ventilatory Assist ◽  
Mean Values ◽  
Ventilatory Assist ◽  
Postmenstrual Age ◽  
Acute Increase ◽  
The Mean

Objective: To analyze the proportion of backup ventilation during neurally adjusted ventilatory assist (NAVA) in preterm infants at different gestational ages and to analyze the trends in backup ventilation in relation to clinical deteriorations. Methods: A prospective observational study was conducted in 18 preterm infants born at a median (range) 27 (23–34) weeks of gestation with a median (range) birth weight of 1,100 (460–2,820) g, who received respiratory support with either invasive or noninvasive NAVA. Data on ventilator settings and respiratory variables were collected daily; the mean values of each 24-hour recording were computed for each respiratory variable. For clinical deterioration, ventilator data were reviewed at 6-hour intervals for 30 hours prior to the event. Results: A total of 354 ventilator days were included: 269 and 85 days during invasive and noninvasive NAVA, respectively. The time on backup ventilation (%/min) significantly decreased, and the neural respiratory rate increased with increasing postmenstrual age during both invasive and noninvasive NAVA. The median time on backup ventilation was less than 15%/min, and the median neural respiratory rate was more than 45 breaths/min for infants above 26 weeks of gestation during invasive NAVA. The relative backup ventilation significantly increased prior to the episode of clinical deterioration. Conclusion: The proportion of backup ventilation during NAVA showed how the control of breathing matured with increasing gestational age. Even the most immature infants triggered most of their breaths by their own respiratory effort. An acute increase in the proportion of backup ventilation anticipated clinical deterioration.

Non-invasive Neurally Adjusted Ventilatory Assist in Preterm Infants With RDS: Effect of Changing Nava Levels

2021 ◽  
Author(s):  
Julie Lefevere ◽  
Brenda Van Delft ◽  
Michel Vervoort ◽  
Wilfried Cools ◽  
Filip Cools
Keyword(s):  
Preterm Infants ◽  
Peak Inspiratory Pressure ◽  
Maximum Level ◽  
Electrical Signal ◽  
Preterm Neonates ◽  
Neurally Adjusted Ventilatory Assist ◽  
Clinical Trial Registration ◽  
Convenience Sample ◽  
Non Invasive ◽  
Ventilatory Assist

Abstract We aimed to examine the effect of changing levels of support (NAVA level) during non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants with respiratory distress syndrome (RDS) on electrical diaphragm activity. This is a prospective, single-centre, interventional, exploratory study in a convenience sample. Clinically stable preterm infants supported with NIV-NAVA for RDS were eligible. Patients were recruited in the first 24 hours after the start of NIV-NAVA. Following a predefined titration protocol, NAVA levels were progressively increased starting from a level of 0,5 cmH2O/µV and with increments of 0,5 cmH2O/µV every 3 minutes, up to a maximum level of 4,0 cmH2O/µV. We measured the evolution of peak inspiratory pressure (PIP) and the electrical signal of the diaphragm (Edi) during NAVA level titration. Twelve infants with a mean (SD) gestational age at birth of 30,6 (3,5) weeks and birth weight of 1454 (667) g were enrolled. For all patients a breakpoint could be identified during the titration study. The breakpoint was on average (SD) at a level of 2,33 (0,58) cmH2O/µV. With increasing NAVA levels, the respiratory rate decreased significantly. No severe complications occurred.Conclusions: Preterm neonates with RDS supported with NIV-NAVA display a biphasic response to changing NAVA levels with an identifiable breakpoint. This breakpoint was at a higher NAVA level than commonly used in this clinical situation. Immature neural feedback mechanisms warrant careful monitoring of preterm infants when supported with NIV-NAVA.Clinical trial registration: clinicaltrials.gov NCT03780842. Date of registration December 12, 2018.

scholarly journals The evaluation of the efficacy and safety of non-invasive neurally adjusted ventilatory assist in combination with INtubation-SURfactant-Extubation technique for infants at 28 to 33 weeks of gestation with respiratory distress syndrome

2019 ◽  
Vol 7 ◽  
pp. 205031211983841 ◽  
Author(s):  
Jun Miyahara ◽  
Hiroshi Sugiura ◽  
Shigeru Ohki
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Periventricular Leukomalacia ◽  
Extubation Failure ◽  
Neurally Adjusted Ventilatory Assist ◽  
Efficacy And Safety ◽  
Non Invasive ◽  
Ventilatory Assist

Objectives: The aim of this study is to evaluate the efficacy and safety of non-invasive neurally adjusted ventilatory assist used after INtubation-SURfactant-Extubation in preterm infants with respiratory distress syndrome. Methods: We conducted a prospective observational study that included 15 inborn preterm infants at 28 (0/7) to 33 (6/7) weeks of gestation with respiratory distress syndrome in the period from April 2017 to October 2018. After INtubation-SURfactant-Extubation, infants underwent non-invasive neurally adjusted ventilatory assist. INtubation-SURfactant-Extubation failure was defined as follows: fraction of inspired oxygen requirement >0.4, respiratory acidosis, and severe apnea within 5 days after surfactant administration. Results: Two of the 15 (13.3%) infants showed INtubation-SURfactant-Extubation failure and required mechanical ventilation. No infants experienced any major complications such as pneumothorax, patent ductus arteriosus ligation, severe intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or death. Conclusion: The rate of INtubation-SURfactant-Extubation failure when non-invasive neurally adjusted ventilatory assist was used after INtubation-SURfactant-Extubation for preterm infants with respiratory distress syndrome was 13.3%. Non-invasive neurally adjusted ventilatory assist can be safely performed without severe complications for preterm infants soon after birth.

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