Effects of Neurally Adjusted Ventilatory Assist (NAVA) levels in non-invasive ventilated patients: titrating NAVA levels with electric diaphragmatic activity and tidal volume matching

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.

Download Full-text

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

SAGE Open Medicine ◽

10.1177/2050312119838417 ◽

2019 ◽

Vol 7 ◽

pp. 205031211983841 ◽

Cited By ~ 1

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.

Download Full-text

Neurally adjusted ventilatory assist after surgical treatment of intracerebral hemorrhage: a randomized crossover study

Journal of International Medical Research ◽

10.1177/0300060520939837 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052093983

Author(s):

Tao Yu ◽

Rongrong Wu ◽

Lin Yao ◽

Kui Wang ◽

Guiliang Wang ◽

...

Keyword(s):

Surgical Treatment ◽

Intracerebral Hemorrhage ◽

Crossover Study ◽

Tidal Volume ◽

Respiratory Pattern ◽

Neurally Adjusted Ventilatory Assist ◽

Clinical Trial Registration ◽

Diaphragmatic Function ◽

Ventilatory Assist ◽

Randomized Crossover Study

Objective We assessed the neuromechanical efficiency (NME), neuroventilatory efficiency (NVE), and diaphragmatic function effects between pressure support ventilation (PSV) and neutrally adjusted ventilatory assist (NAVA). Methods Fifteen patients who had undergone surgical treatment of intracerebral hemorrhage were enrolled in this randomized crossover study. The patients were assigned to PSV for the first 24 hours and then to NAVA for the following 24 hours or vice versa. The monitored ventilatory parameters under the two ventilation models were compared. NME, NVE, and diaphragmatic function were compared between the two ventilation models. Results One patient’s illness worsened during the study. The study was stopped for this patient, and intact data were obtained from the other 14 patients and analyzed. The monitored tidal volume was significantly higher with PSV than NAVA (487 [443–615] vs. 440 [400–480] mL, respectively). NME, NVE, diaphragmatic function, and the partial pressures of arterial carbon dioxide and oxygen were not significantly different between the two ventilation models. Conclusion The tidal volume was lower with NAVA than PSV; however, the patients’ selected respiratory pattern during NAVA did not change the NME, NVE, or diaphragmatic function. Clinical trial registration no. ChiCTR1900022861

Download Full-text

Neurally Adjusted Ventilatory Assist in Critically Ill Postoperative Patients: A Crossover Randomized Study

Anesthesiology ◽

10.1097/aln.0b013e3181ee2ef1 ◽

2010 ◽

Vol 113 (4) ◽

pp. 925-935 ◽

Cited By ~ 57

Author(s):

Yannael Coisel ◽

Gerald Chanques ◽

Boris Jung ◽

Jean-Michel Constantin ◽

Xavier Capdevila ◽

...

Keyword(s):

Mechanical Ventilation ◽

Gas Exchange ◽

Electrical Activity ◽

Tidal Volume ◽

Critically Ill ◽

Neurally Adjusted Ventilatory Assist ◽

Exchange Effects ◽

Ventilatory Parameters ◽

Ventilatory Assist ◽

Ventilation Modes

Background Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to the electrical activity of the diaphragm. This study aimed to compare the ventilatory and gas exchange effects between NAVA and pressure support ventilation (PSV) during the weaning phase of critically ill patients who required mechanical ventilation subsequent to surgery. Methods Fifteen patients, the majority of whom underwent abdominal surgery, were enrolled. They were ventilated with PSV and NAVA for 24 h each in a randomized crossover order. The ventilatory parameters and gas exchange effects produced by the two ventilation modes were compared. The variability of the ventilatory parameters was also evaluated by the coefficient of variation (SD to mean ratio). Results Two patients failed to shift to NAVA because of postoperative bilateral diaphragmatic paralysis, and one patient interrupted the study because of worsening of his sickness. In the other 12 cases, the 48 h of the study protocol were completed, using both ventilation modes, with no signs of intolerance or complications. The Pao2/Fio2 (mean ± SD) ratio in NAVA was significantly higher than with PSV (264 ± 71 vs. 230 ± 75 mmHg, P < 0.05). Paco2 did not differ significantly between the two modes. The tidal volume (median [interquartile range]) with NAVA was significantly lower than with PSV (7.0 [6.4-8.6] vs. 6.5 [6.3-7.4] ml/kg predicted body weight, P < 0.05).Variability of insufflation airway pressure, tidal volume, and minute ventilation were significantly higher with NAVA than with PSV. Electrical activity of the diaphragm variability was significantly lower with NAVA than with PSV. Conclusions Compared with PSV, respiratory parameter variability was greater with NAVA, probably leading in part to the significant improvement in patient oxygenation.

Download Full-text