scholarly journals Neurally Adjusted Ventilatory Assist in Very Prematurely Born Infants with Evolving/Established Bronchopulmonary Dysplasia

2021 ◽  
Vol 11 (04) ◽  
pp. e127-e131
Author(s):  
Sandeep Shetty ◽  
Katie Evans ◽  
Peter Cornuaud ◽  
Anay Kulkarni ◽  
Donovan Duffy ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Total Duration ◽  
Extubation Failure ◽  
Feeding Tube ◽  
Neurally Adjusted Ventilatory Assist ◽  
Nasogastric Feeding ◽  
Ventilatory Assist ◽  
Historical Controls ◽  
Prematurely Born Infants

Abstract Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Objective Our objective was to determine whether NAVA/NIV-NAVA has advantages in infants with evolving/established bronchopulmonary dysplasia (BPD). Methods Each infant who received NAVA/NIV-NAVA and conventional invasive and NIV was matched with two historical controls. Eighteen NAVA/NIV-NAVA infants’ median gestational age, 25.3 (23.6–28.1) weeks, was compared with 36 historical controls’ median gestational age 25.2 (23.1–29.1) weeks. Results Infants on NAVA/NIV-NAVA had lower extubation failure rates (median: 0 [0–2] vs. 1 [0–6] p = 0.002), shorter durations of invasive ventilation (median: 30.5, [1–90] vs. 40.5 [11–199] days, p = 0.046), and total duration of invasive and NIV to the point of discharge to the local hospital (median: 80 [57–140] vs. 103.5 [60–246] days, p = 0.026). The overall length of stay (LOS) was lower in NAVA/NIVNAVA group (111.5 [78–183] vs. 140 [82–266] days, p = 0.019). There were no significant differences in BPD (17/18 [94%] vs. 32/36 [89%] p = 0.511) or home oxygen rates (14/18 [78%] vs. 23/36 [64%] p = 0.305). Conclusion The combination of NAVA/NIV-NAVA compared with conventional invasive and NIV modes may be advantageous for preterm infants with evolving/established BPD.

Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia

2020 ◽  
Author(s):  
Robin L. McKinney ◽  
Martin Keszler ◽  
William E. Truog ◽  
Michael Norberg ◽  
Richard Sindelar ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Noninvasive Positive Pressure Ventilation ◽  
Median Number ◽  
Standards Of Care ◽  
Positive Pressure ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist ◽  
Postmenstrual Age ◽  
The Impact

Abstract Objective The aim of this study is to determine patterns of neurally adjusted ventilatory assist (NAVA) use in ventilator-dependent preterm infants with evolving or established severe bronchopulmonary dysplasia (sBPD) among centers of the BPD Collaborative, including indications for its initiation, discontinuation, and outcomes. Study Design Retrospective review of infants with developing or established sBPD who were placed on NAVA after ≥4 weeks of mechanical ventilation and were ≥ 30 weeks of postmenstrual age (PMA). Results Among the 13 sites of the BPD collaborative, only four centers (31%) used NAVA in the management of infants with evolving or established BPD. A total of 112 patients met inclusion criteria from these four centers. PMA, weight at the start of NAVA and median number of days on NAVA, were different among the four centers. The impact of NAVA therapy was assessed as being successful in 67% of infants, as defined by the ability to achieve respiratory stability at a lower level of ventilator support, including extubation to noninvasive positive pressure ventilation or support with a home ventilator. In total 87% (range: 78–100%) of patients survived until discharge. Conclusion We conclude that NAVA can be used safely and effectively in selective infants with sBPD. Indications and current strategies for the application of NAVA in infants with evolving or established BPD, however, are highly variable between centers. Although this pilot study suggests that NAVA may be successfully used for the management of infants with BPD, sufficient experience and well-designed clinical studies are needed to establish standards of care for defining the role of NAVA in the care of infants with sBPD.

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.

Noninvasive Neurally Adjusted Ventilatory Assist Versus High Flow Cannula Support After Congenital Heart Surgery

2019 ◽  
Vol 10 (5) ◽  
pp. 565-571
Author(s):  
Nirbhay Parashar ◽  
Matthew Amidon ◽  
Abdulhamid Milad ◽  
Adam Devine ◽  
Li Yi ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Extubation Failure ◽  
Congenital Heart Surgery ◽  
High Flow ◽  
Neurally Adjusted Ventilatory Assist ◽  
Icu Discharge ◽  
Significant Difference ◽  
Historical Controls

Background: Extubation failure rates for critical patients in pediatric intensive care units (ICUs) range from 5% to 29%. Noninvasive (NIV) ventilation has been shown to decrease extubation failure. We compared reintubation rates and outcomes of patients supported with NIV neurally adjusted ventilation assist (NAVA) versus historical controls supported with high-flow nasal cannula (HFNC). Methods: Case–control study of infants less than three months of age who underwent cardiac surgery and received NIV support after extubation from January 2011 to May 2017. All patients supported with NIV NAVA after it became available in September 2013 were compared to matched patients extubated to HFNC from prior to September 2013. Results: Forty-two patients identified for the NIV NAVA group were matched with 42 historical controls supported with HFNC. Groups had similar baseline characteristics based on rate of acute kidney injury, number of single ventricle patients, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, age, weight, bypass time, and duration of intubation. There was no significant difference in reintubation rates within 72 hours (14.3% in the HFNC group and 16.7% in the NIV NAVA group, P = 1.0). Median duration from extubation to coming off NIV support was longer in the NIV NAVA group (3.6 days vs 0.6 days, P < .001). Median time from extubation to ICU discharge was longer in the NIV NAVA group (10.5 vs 6.8 days, P = .02), as was total postoperative ICU length of stay (LOS; 17.6 vs 12.2, P = .01). Conclusions: Introduction of NIV NAVA for postextubation support did not reduce reintubation rates compared to HFNC. Further study is needed as adoption of NIV NAVA may prolong LOS.

scholarly journals Tracheal opening manoeuvre (PEEP-20) in a patient with bronchopulmonary dysplasia and severe tracheobronchomalacia with neurally adjusted ventilatory assist (NAVA)

2020 ◽  
Vol 13 (1) ◽  
pp. e229471
Author(s):  
Maite Olguin Ciancio ◽  
Francisco José Cambra ◽  
Martí Pons-Odena
Keyword(s):  
Case Report ◽  
Bronchopulmonary Dysplasia ◽  
Ventilatory Support ◽  
Neurally Adjusted Ventilatory Assist ◽  
Positive End Expiratory Pressure ◽  
Good Patient ◽  
Airway Collapse ◽  
Ventilatory Assist ◽  
Ventilator Synchrony

Bronchopulmonary dysplasia (BPD) is occasionally associated with tracheobronchomalacia, and it is this combination that can lead to serious outcomes. The most severe cases require tracheostomies, ventilatory support and eventually even tracheal stents or surgery. Ventilation in patients with tracheomalacia is complicated without a good patient-ventilator synchrony; the neurally adjusted ventilatory assist (NAVA) mode is potentially beneficial in these cases. This case report presents a patient affected by BPD and severe tracheobronchomalacia who was tracheostomised and ventilated 24 hours a day and who suffered from episodes of airway collapse despite using the NAVA mode. It was necessary to increase the positive end-expiratory pressure to 20 cmH2O (the PEEP-20 manoeuvre) for several minutes during an episode; this allowed the trachea to remain open and allowed us to optimise the patient’s ventilation. This strategy has previously been described in a patient with tracheomalacia, reducing the frequency and need for sedation in the following episodes.

scholarly journals Risk Factors and Outcomes of Pulmonary Hypertension in Infants With Bronchopulmonary Dysplasia: A Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Ying Chen ◽  
Di Zhang ◽  
Ying Li ◽  
Aixia Yan ◽  
Xiaoying Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Meta Analysis ◽  
Total Duration ◽  
Morbidity And Mortality ◽  
Meta Analyses

Background: Pulmonary hypertension is one of the most common co-morbidities in infants with bronchopulmonary dysplasia (BPD), but its risk factors are unclear. The onset of pulmonary hypertension in BPD has been associated with poor morbidity- and mortality-related outcomes in infants. Two review and meta-analysis studies have evaluated the risk factors and outcomes associated with pulmonary hypertension in infants with BPD. However, the limitations in those studies and the publication of recent cohort studies warrant our up-to-date study. We designed a systematic review and meta-analysis to evaluate the risk factors and outcomes of pulmonary hypertension in infants with BPD.Objective: To systematically evaluate the risk factors and outcomes associated with pulmonary hypertension in infants with BPD.Methods: We systematically searched the academic literature according to the PRISMA guidelines across five databases (Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE). We conducted random-effects meta-analyses to evaluate the pulmonary hypertension risk factors in infants with BPD. We also evaluated the overall morbidity- and mortality-related outcomes in infants with BPD and pulmonary hypertension.Results: We found 15 eligible studies (from the initial 963 of the search result) representing data from 2,156 infants with BPD (mean age, 25.8 ± 0.71 weeks). The overall methodological quality of the included studies was high. Our meta-analysis in infants with severe BPD revealed increased risks of pulmonary hypertension [Odds ratio (OR) 11.2], sepsis (OR, 2.05), pre-eclampsia (OR, 1.62), and oligohydramnios (OR, 1.38) of being small for gestational age (3.31). Moreover, a comparative analysis found medium-to-large effects of pulmonary hypertension on the total duration of hospital stay (Hedge's g, 0.50), the total duration of oxygen received (g, 0.93), the cognitive score (g, −1.5), and the overall mortality (g, 0.83) in infants with BPD.Conclusion: We identified several possible risk factors (i.e., severe BPD, sepsis, small for gestational age, pre-eclampsia) which promoted the onset of pulmonary hypertension in infants with BPD. Moreover, our review sheds light on the morbidity- and mortality-related outcomes associated with pulmonary hypertension in these infants. Our present findings are in line with the existing literature. The findings from this research will be useful in development of efficient risk-based screening system that determine the outcomes associated with pulmonary hypertension in infants with BPD.

scholarly journals The Effectiveness of the Heated Humidified High Flow Nasal Cannula as a Noninvasive Respiratory Support for Preterm Infants for Prevention of Extubation Failure

2020 ◽  
pp. 44-56
Author(s):  
Sarah Mohamed Nofal ◽  
May Rabie El- Sheikh ◽  
Heba Saed El- Mahdy ◽  
Mostafa Mohamed Awny
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Flow Rate ◽  
Gestational Age ◽  
Total Duration ◽  
Extubation Failure ◽  
Respiratory Support ◽  
Flow Rates ◽  
Duration Of Hospitalization ◽  
Nasal Trauma

Aims: To compare the efficacy and safety of the HHHFNC as a post extubation respiratory support of preterm infants who were initially required endotracheal intubation and conventional mechanical ventilator after birth at different flow rates (3 L/min and 6 L/min). Study Design: A Randomized controlled trial. Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019. Methodology: 30 preterm, with gestational age (30-36) weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min to prevent postextubation failure. Primary outcomes: the incidence of treatment failure of the HHHFNC at flow 3 and 6 L/min, which will require n CPAP or NIMV, or will require reintubation after successful extubation within 72 h. Secondary outcomes: rate of deaths within 72 hours post extubation, the total duration of all types of oxygen support, total duration of hospitalization and incidence of neonatal morbidities such as nasal trauma, BPD, symptomatic PDA, IVH ≥ grade II, pneumothorax, pulmonary hemorrhage, ROP, apnea, sepsis and NEC ≥ stage II. Results: The incidence of need for higher flow rate of HHHFNC (n =17, 56.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n =16, 53.3%), the need for intubation & MV (n =7, 23.3%), the incidence of nasal trauma (n =9, 30%), BPD (n =9, 30%) , IVH ≥ II (n =7, 23.3%) , NEC ≥ II (n =0), pneumothorax ( n =5, 16.6%) , pulmonary haemorrhage (n =3, 10%), death (n =3, 10%), median duration of hospitalization in days =22.5 (17-28), median duration of all oxygen support in days = 18 (15-21), so the failure rate was 17 out of 30 (56.6%). Conclusion: HHHFNC use is noninferior to other forms of noninvasive respiratory support in preterm infants for prevention of extubation failure. There were better outcomes of HHHFNC with higher gestational age and birth weight in preterm infants at either flow rates 3 or 6 L/min.

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