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.
Monitoring the respiratory rate of preterm infants using an ultrathin film sensor embedded in the bedding: a comparative feasibility study
