scholarly journals Neurally Adjusted Ventilatory Assist Increases Respiratory Variability and Complexity in Acute Respiratory Failure

2010 ◽  
Vol 112 (3) ◽  
pp. 670-681 ◽  
Author(s):  
Matthieu Schmidt ◽  
Alexandre Demoule ◽  
Christophe Cracco ◽  
Alexandre Gharbi ◽  
Marie-Noëlle Fiamma ◽  
...  
Keyword(s):  
Lyapunov Exponent ◽  
Breathing Pattern ◽  
Ventilatory Support ◽  
Phase Portraits ◽  
Positive Pressure ◽  
Largest Lyapunov Exponent ◽  
Neurally Adjusted Ventilatory Assist ◽  
Dependent Manner ◽  
Ventilatory Assist ◽  
Respiratory Variability

Background Neurally adjusted ventilatory assist (NAVA) is a partial ventilatory support mode where positive pressure is provided in relation to diaphragmatic electrical activity (EAdi). Central inspiratory activity is normally not monotonous, but it demonstrates short-term variability and complexity. The authors reasoned that NAVA should produce a more "natural" or variable breathing pattern than other modes. This study compared respiratory variability and complexity during pressure support ventilation (PSV) and NAVA. Methods Flow and EAdi were recorded during routine PSV (tidal volume approximately 6-8 ml/kg) and four NAVA levels (1-4 cm H2O/microVEAdi) in 12 intubated patients. Breath-by-breath variability of flow and EAdi-related variables was quantified by the coefficient of variation (CV) and autocorrelation analysis. Complexity of flow and EAdi was described using noise titration, largest Lyapunov exponent, Kolmogorov-Sinai entropy, and three-dimensional phase portraits. Results Switching from PSV to NAVA increased the CV and decreased the autocorrelation for most flow-related variables in a dose-dependent manner (P < 0.05, partial eta for the CV of mean inspiratory flow 0.642). The changes were less marked for EAdi. A positive noise limit was consistently found for flow and EAdi. Largest Lyapunov exponent and Kolmogorov-Sinai entropy for flow were greater during NAVA than PSV and increased with NAVA level (P < 0.05, partial eta 0.334 and 0.312, respectively). Largest Lyapunov exponent and Kolmogorov-Sinai entropy for EAdi were not influenced by ventilator mode. Conclusions Compared with PSV, NAVA increases the breathing pattern variability and complexity of flow, whereas the complexity of EAdi is unchanged. Whether this improves clinical outcomes remains to be determined.

Cheyne–Stokes breathing pattern and neurally adjusted ventilatory assist in a neuro-critical patient

2019 ◽  
Vol 46 (3) ◽  
pp. 540-541 ◽  
Author(s):  
Gianmaria Cammarota ◽  
Ilaria Sguazzotti ◽  
Francesco Della Corte ◽  
Rosanna Vaschetto
Keyword(s):  
Breathing Pattern ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist ◽  
Cheyne Stokes Breathing

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 Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Xueyan Yuan ◽  
Xinxing Lu ◽  
Yali Chao ◽  
Jennifer Beck ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Practice ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Cochrane Library ◽  
Neurally Adjusted Ventilatory Assist ◽  
Partial Support ◽  
Ventilatory Assist

Abstract Background Prolonged ventilatory support is associated with poor clinical outcomes. Partial support modes, especially pressure support ventilation, are frequently used in clinical practice but are associated with patient–ventilation asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient–ventilator asynchrony, may be an alternative for weaning. However, the effects of NAVA on weaning outcomes in clinical practice are unclear. Methods We searched PubMed, Embase, Medline, and Cochrane Library from 2007 to December 2020. Randomized controlled trials and crossover trials that compared NAVA and other modes were identified in this study. The primary outcome was weaning success which was defined as the absence of ventilatory support for more than 48 h. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with accompanying 95% confidence interval (CI) were expressed. Results Seven studies (n = 693 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with other partial support modes (OR = 1.93; 95% CI 1.12 to 3.32; P = 0.02). For the secondary outcomes, NAVA may reduce duration of mechanical ventilation (MD = − 2.63; 95% CI − 4.22 to − 1.03; P = 0.001) and hospital mortality (OR = 0.58; 95% CI 0.40 to 0.84; P = 0.004) and prolongs ventilator-free days (MD = 3.48; 95% CI 0.97 to 6.00; P = 0.007) when compared with other modes. Conclusions Our study suggests that the NAVA mode may improve the rate of weaning success compared with other partial support modes for difficult to wean patients.

Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury*

2006 ◽  
Vol 34 (12) ◽  
pp. 2997-3004 ◽  
Author(s):  
Jean-Christophe Allo ◽  
Jennifer C. Beck ◽  
Lukas Brander ◽  
Fabrice Brunet ◽  
Arthur S. Slutsky ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Breathing Pattern ◽  
Neurally Adjusted Ventilatory Assist ◽  
Positive End Expiratory Pressure ◽  
Ventilatory Assist

Neurally adjusted ventilatory assist increases respiratory variability and improves patient-ventilator synchronisation

2016 ◽  
Vol 84 (4) ◽  
pp. 231-232
Author(s):  
F. García-Muñoz Rodrigo ◽  
L. Urquía Marti ◽  
G. Galán Henríquez ◽  
S. Rivero Rodríguez ◽  
C. Siles Quesada
Keyword(s):  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist ◽  
Respiratory Variability
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