Neurally-Adjusted Ventilatory Assist Versus Pressure Support Ventilation During Noninvasive Ventilation.

Abstract

Noninvasive ventilation (NIV) is increasingly used during ventilatory support. Neurally-adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that can improve patient-ventilator interaction. We conducted a meta-analysis to compare patient-ventilator interaction and clinical outcomes between NAVA and pressure support ventilation (PSV) in adult subjects during NIV. The PubMed, Cochrane Library, Web of Science, OpenGrey, and Embase databases were searched for appropriate clinical trials comparing NIV-NAVA with NIV-PSV for adult subjects. Comparisons of asynchrony index (AI), types of asynchrony, and clinical outcomes were pooled. Fifteen studies were included involving 615 subjects. AI was significantly lower in NAVA than PSV group (mean difference [MD] -14.70 [95% CI -23.20 to -6.19], P < .001). Subgroup analysis grouped by exacerbation of COPD or non-COPD showed that the AI of NAVA was lower than PSV in COPD exacerbation (MD -14.56 [95% CI -21.04 to -8.09], P < .001) and non-COPD (MD -3.02 [95% CI -4.44 to -1.61], P < .001). Severe asynchrony was significantly lower in NAVA than in PSV (odds ratio 0.06 [95% CI 0.03-0.11], P < .001). Inspiratory trigger delay in NAVA was significantly lower than PSV (MD -129.60 [95% CI -148.43 to -110.78], P < .001). NAVA had longer ICU length of stay than PSV (MD 1.22 [95% CI 0.44-2.00], P = .002). Level of discomfort was significantly higher in NAVA group than PSV group (MD 0.62 [95% CI 0.02-1.21], P = .040). NAVA has advantages in ventilator-patient interaction compared to PSV in NIV. Further research is needed in order to estimate effects on clinical outcomes.