Neurally Adjusted Ventilatory Assist in Preterm Infants With Established or Evolving Bronchopulmonary Dysplasia on High-Intensity Mechanical Ventilatory Support

2016 ◽  
Vol 17 (12) ◽  
pp. 1142-1146 ◽  
Author(s):  
Young Hwa Jung ◽  
Han-Suk Kim ◽  
Juyoung Lee ◽  
Seung Han Shin ◽  
Ee-Kyung Kim ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
High Intensity ◽  
Ventilatory Support ◽  
Neurally Adjusted Ventilatory Assist ◽  
Mechanical Ventilatory Support ◽  
Ventilatory Assist

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 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

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 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.

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.

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