COMPARISON OF IMPACT FOR DIFFERENT MODES OF VENTILATION ON CEREBRAL BLOOD FLOW IN TERM INFANTS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Abstract

In nowadays there are no published results of large randomized controlled studies compared the differentiated influence of different modes of ventilation on cerebral perfusion in newborns with hypoxic-ischemic encephalopathy. New mode of ventilation named Neurally Adjusted Ventilatory Assist (NAVA) looks promising on this field, because it has already proved its advantages in premature babies.OBJECTIVETo compare the impact of Neurally Adjusted Ventilatory Assist and other modes of ventilation on cerebral blood flow in the acute period of HIE in full-term neonates.MATERIALS AND METHODSData of 205 term infants with hypoxic-ischemic encephalopathy Sarnat stage II-III was collected during ≤72 hours of life. All the infants were randomized into group of NAVA (n=16) and the control group (n=189), which included such modes of ventilation as PC, SIMV/PSV and PRVC. A multivariate dispersion analysis of the impact for NAVA and other modes of ventilation on cerebral perfusion during the acute period of neonatal hypoxic-ischemic encephalopathy was performed.RESULTS AND DISCUSSIONA significant difference was found between groups on the 3rd day of treatment at the end of the period of therapeutic hypothermia and the rewarming beginning in Doppler Resistive Index of cerebral blood flow RI (0.70 [0.67-0.74] in the NAVA group and 0.66 [0.58-0.72] in the control group, p=0.021) and the Pulsatile Index PI (1.3 [1.2-1.5] in the NAVA group and 1.2 [1.0-1.40] in the control group, p=0.032). Also, ANOVA test results confirmed, that compared with other ventilation modes, NAVA had a statistically significant positive influence at the 2nd and 3rd day of observation both on the RI (p=0.009) and on the PI index (p=0.012).CONCLUSIONSThe Neurally Adjusted Ventilatory Assist demonstrated a positive impact on cerebral perfusion indices in full-term newborns during the acute HIE period compared with traditional modes of ventilation PC, SIMV / PSV and PRVC.