Abstract
IntroductionDelivering synchronous assist during non-invasive ventilation (NIV) is challenging with flow- or pressure-controlled ventilators, especially in patients with chronic obstructive pulmonary disease (COPD). Neurally adjusted ventilatory assist (NAVA) uses diaphragm electrical activity (EAdi) to control the ventilator. We evaluated patient-ventilator interaction in patients with COPD during NIV with pressure support ventilation (PSV) and NAVA using a recently introduced automated analysis.MethodsTwelve COPD patients underwent three 30-minute trials: 1) PSV with dedicated NIV ventilator (NIV-PSVVision), 2) PSV with intensive care unit (ICU) ventilator (NIV-PSVServo-I), and 3) with NIV-NAVA. EAdi, flow, and airway pressure were recorded. Patient-ventilator interaction was evaluated by comparing airway pressure and EAdi waveforms with automated computer algorithms. The NeuroSync index was calculated as the percentage of timing errors between airway pressure and EAdi.ResultsThe NeuroSync index was higher (larger error) for NIV-PSVVision (24 (IQR 15 to 30) %) and NIV-PSVServo-I (21 (IQR 15 to 26) %) compared to NIV-NAVA (5 (IQR 4 to 7) %; P <0.001). Wasted efforts, trigger delays and cycling-off errors were less with NAVA (P <0.05 for all). The NeuroSync index and the number of wasted efforts were strongly correlated (r2 = 0.84), with a drastic increase in wasted efforts after timing errors reach 20%.ConclusionsIn COPD patients, non-invasive NAVA improves patient-ventilator interaction compared to PSV, delivered either by a dedicated or ICU ventilator. The automated analysis of patient-ventilator interaction allowed for an objective detection of patient-ventilator interaction during NIV. In addition, we found that progressive mismatch between neural effort and pneumatic timing is associated with wasted efforts.
Highlights
Delivering synchronous assist during non-invasive ventilation (NIV) is challenging with flow- or pressure-controlled ventilators, especially in patients with chronic obstructive pulmonary disease (COPD)
For the above-stated reasons, the aim of the present study was to evaluate patient-ventilator interaction, using an automated analysis, in COPD patients with NIV-pressure support ventilation (PSV) delivered by a dedicated NIV ventilator, and non-invasive pressure support ventilation (NIV-PSV) and NIV-Neurally adjusted ventilatory assist (NAVA) delivered by an intensive care unit (ICU) ventilator
Automated analysis of patient-ventilator interaction showed that non-invasive NAVA improves patient-ventilator interaction compared to PSV in COPD patients
Summary
Delivering synchronous assist during non-invasive ventilation (NIV) is challenging with flow- or pressure-controlled ventilators, especially in patients with chronic obstructive pulmonary disease (COPD). Adjusted ventilatory assist (NAVA) uses diaphragm electrical activity (EAdi) to control the ventilator. We evaluated patient-ventilator interaction in patients with COPD during NIV with pressure support ventilation (PSV) and NAVA using a recently introduced automated analysis. NIV utilization has increased over time among patients hospitalized for acute exacerbation of COPD, whereas the need for intubation has declined [2]. Despite these positive reports, some patients treated with NIV fail and require invasive. Recent studies in heterogeneous groups of critically ill patients show that non-invasive NAVA (NIV-NAVA) improves patientventilator interaction relative to non-invasive pressure support ventilation (NIV-PSV) [15,16,17,18]
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