Application of neurally adjusted ventilation assist on patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract

Objective To compare the difference between neurally adjusted ventilation assist (NAVA) and synchronized intermittent mandatory ventilation with pressure support ventilation (SIMV+ PSV) on the treatment of patients with respiratory failure in the acute exacerbation of chronic obstructive pulmonary diseases(AECOPD). Methods Sixty mechanically ventilated patients with respiratory failure in AECOPD were randomly allocated to NAVA group (n=30) and SIMV+ PSV group (n=30). Observe the parameters of patient-ventilator interaction such as trigger delay time, cycling-off delay time, ineffective trigger number and ineffective trigger index, and the parameters of respiratory mechanics such as patient′s work of breathing and it′s proportion in total work of breathing were measured.The levels of interleukin-6 and interleukin-8 in serum were detected by enzyme-linked immunosorbent assay.The rate of direct weaning from mechanical ventilation and total mechanical ventilation time were also observed. Results The trigger delay time, cycling-off delay time and patient′s work of breathing in the NAVA group were statistically lower than those in the SIMV+ PSV group (Trigger delay time: 1 h, 24 h, 48 h, 72 h t=-13.69, -12.55, -11.87, -14.34.cycling-off delay time: 1 h, 24 h, 48 h, 72 h t=8.22, 14.60, 12.89, 11.66.Patient′s work of breathing: 1 h, 24 h, 48 h, 72 h t=-12.99, -13.70, -10.41, -19.66.All P 0.05.72 h t=-6.50, P 0.05.72 h t=-6.23, P 0.05). But in NAVA group, the total mechanical ventilation time was statistically lower than that in SIMV+ PSV group (t=3.22, P<0.05). Conclusions Compared with SIMV+ PSV, NAVA could significantly improve the patient-ventilation interaction in mechanically ventilated patients with AECOPD complicated with respiratory failure, reducing respiratory load and the risk of ventilator-associated lung injury, and shortening the duration of mechanical ventilation, therefore it may improve the prognosis of patients. Key words: Acute excerbation of chronic obstructive pulmonary disease; Neurally adjusted ventilation assist; Synchronized intermittent mandatory ventilation; Pressure support ventilation; Patient-ventilation interaction; Ventilation-associated lung injury