Abstract
BackgroundNeurally adjusted ventilatory assist (NAVA) is an innovative mode for assisted ventilation that improves patient-ventilator interaction in children. The aim of this study was to assess the effects of patient-ventilator interaction comparing NAVA with pressure support ventilation (PSV) in patients difficult to wean from mechanical ventilation after moderate pediatric acute respiratory distress syndrome (PARDS).MethodsIn this physiological crossover study, 12 patients admitted in the Pediatric Intensive Care Unit (PICU) with moderate PARDS failing up to 3 spontaneous breathing trials in less than 7 days, were enrolled. Patients underwent three study conditions lasting 1 h each: PSV1, NAVA and PSV2.ResultsThe Asynchrony Index (AI) was significantly reduced during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.001). During the NAVA trial, the inspiratory and expiratory trigger delays were significantly shorter compared to those obtained during PSV1 and PSV2 trials (Delaytrinspp < 0.001, Delaytrexpp = 0.013). These results explain the significantly longer Timesync observed during the NAVA trial (p < 0.001). In terms of gas exchanges, PaO2 value significantly improved in the NAVA trial with respect to the PSV trials (p < 0.02). The PaO2/FiO2 ratio showed a significant improvement during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.004).ConclusionsIn this specific PICU population, presenting difficulty in weaning after PARDS, NAVA was associated with a reduction of the AI and a significant improvement in oxygenation compared to PSV mode.Trial registrationClinicalTrial.gov Identifier: NCT04360590 “Retrospectively registered”.
Highlights
Adjusted ventilatory assist (NAVA) is an innovative mode for assisted ventilation that improves patient-ventilator interaction in children
Baseline characteristics From January 1st 2011 to January 31st 2014, 48 pediatric patients were admitted in Pediatric Intensive Care Unit (PICU) with a diagnosis of moderate pediatric acute respiratory distress syndrome (PARDS)
During the Neurally adjusted ventilatory assist (NAVA) trial, the inspiratory and expiratory trigger delays were significantly shorter compared to the delay values observed during PSV1 and PSV2 trials (Delaytrinsp p < 0.001, Delaytrexp p = 0.013): these results explain the significantly longer Timesync observed during the NAVA trial (p < 0.001)
Summary
Adjusted ventilatory assist (NAVA) is an innovative mode for assisted ventilation that improves patient-ventilator interaction in children. It is nowadays well known that asynchronous phenomena are frequent and are likely correlated to multiple factors, including machine characteristics and performance, as well as physiological factors affecting neural respiratory drive, muscle strength, as well as patient’s breathing patterns and respiratory mechanics. The latter two components are crucial in infants and children, where the respiratory system characteristics and the fast breathing patterns may negatively interact with the flow-based ventilatory algorithms, in difficult to wean patients who often show a high rate of asynchrony. A worse patient-ventilator synchrony has been associated with increased days on mechanical ventilation and, increased risk to develop Ventilator Associating Pneumonia (VAP) and other infections [3,4,5,6]
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