scholarly journals Effective neurally-adjusted ventilatory assist weaning off mechanical ventilation in separated conjoined thoraco-omphalopagus twins with sternal MEDPOR implant patch

2020 ◽  
Vol 86 (2) ◽  
Author(s):  
Emanuele Rossetti ◽  
Luigi Dei Giudici ◽  
Roberto Bianchi ◽  
Fabrizio Chiusolo ◽  
Chiara Grimaldi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist

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.

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

2010 ◽  
Vol 113 (4) ◽  
pp. 925-935 ◽  
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.

scholarly journals Neurally Adjusted Ventilatory Assist Is Associated with Greater Initial Extubation Success in Postoperative Congenital Heart Disease Patients when Compared to Conventional Mechanical Ventilation

2018 ◽  
Vol 07 (03) ◽  
pp. 147-158 ◽  
Author(s):  
Nasir Mushtaq ◽  
Kellie Brown ◽  
Vanette Littlefield ◽  
Roger Barton ◽  
Shawn Sood
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Median Duration ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Ventilator Weaning ◽  
Neurally Adjusted Ventilatory Assist ◽  
Initial Attempt ◽  
Ventilatory Assist

AbstractExtubation failure is associated with considerable morbidity and mortality in postoperative patients with congenital heart disease (CHD). The study purpose was to investigate initial extubation success utilizing neurally adjusted ventilatory assist (NAVA) compared with pressure-regulated volume controlled, synchronized intermittent mandatory ventilation with pressure support (SIMV-PRVC + PS) for ventilatory weaning in patients who required prolonged mechanical ventilation (MV). Also, total days on MV, inotropes, sedation, analgesia, and pediatric intensive care unit (PICU) length of stay (LOS) between both groups were compared. This was a non-randomized pilot study utilizing historical controls (SIMV-PRVC + PS; n = 40) compared with a prospective study population (NAVA; n = 35) in a Level I PICU and was implemented to help future trial designs. All patients (n = 75) required prolonged MV ≥96 hours due to their complex postoperative course. Ventilator weaning initiation and management was standardized between both groups. Ninety-seven percent of the NAVA group was successfully extubated on the initial attempt, while 80% were in the SIMV-PRVC + PS group (p = 0.0317). Patients placed on NAVA were eight times more likely to have successful initial extubation (odds ratio [OR]: 8.50, 95% confidence interval [CI]: 1.01, 71.82). The NAVA group demonstrated a shorter median duration on MV (9.0 vs. 11.0 days, p = 0.032), PICU LOS (9.0 vs. 13.5 days, p < 0.0001), and shorter median duration of days on dopamine (8.0 vs. 11.0 days, p = 0.0022), milrinone (9.0 vs. 12.0 days, p = 0.0002), midazolam (8.0 vs. 12.0 days, p < 0.0001), and fentanyl (9.0 vs. 12.5 days, p < 0.0001) compared with the SIMV-PRVC + PS group. NAVA compared with SIMV-PRVC + PS was associated with a greater initial extubation success rate. NAVA should be considered as a mechanical ventilator weaning strategy in postoperative congenital heart disease (CHD) patients and warrants further investigation.

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