Abstract
Both proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) provide pressure support synchronised throughout the respiratory cycle proportional to the patient’s respiratory demand. Our aim was to compare the effect of these two modes on oxygenation in infants with evolving or established bronchopulmonary dysplasia. Two-hour periods of PAV and NAVA were delivered in random order to 18 infants born less than 32 weeks of gestation. Quasi oxygenation indices (“OI”) and alveolar-arterial (“A-a”) oxygen gradients at the end of each period on PAV, NAVA and baseline ventilation were calculated using capillary blood samples. The mean “OI” was not significantly different on PAV compared to NAVA (7.8 (standard deviation (SD) 3.2) versus 8.1 (SD 3.4), respectively, p = 0.70, but lower on both than on baseline ventilation (mean baseline “OI” 11.0 (SD 5.0)), p = 0.002, 0.004, respectively). The “A-a” oxygen gradient was higher on PAV and baseline ventilation than on NAVA (20.8 (SD 12.3) and 22.9 (SD 11.8) versus 18.5 (SD 10.8) kPa, p = 0.015, < 0.001, respectively).Conclusion: Both NAVA and PAV improved oxygenation compared to conventional ventilation. There was no significant difference in the mean “OI” between the two modes, but the mean “A-a” gradient was better on NAVA.What is Known:• Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) can improve the oxygenation index (OI) in prematurely born infants.• Both PAV and NAVA can provide support proportional to respiratory drive or demand throughout the respiratory cycle.What is New:• In infants with evolving or established BPD, using capillary blood samples, both PAV and NAVA compared to baseline ventilation resulted in improvement in the “OI”, but there was no significant difference in the “OI” on PAV compared to NAVA.• The “alveolar-arterial” oxygen gradient was better on NAVA compared to PAV.
Highlights
Mechanical ventilation can be live-saving in the neonatal period but is associated with complications such as bronchopulmonary dysplasia (BPD) and chronic respiratory morbidity [1]
There was no significant difference in the mean “oxygenation indices (OI)” between the two modes, but the mean “A-a” gradient was better on neurally adjusted ventilatory assist (NAVA)
In infants with evolving or established BPD, using capillary blood samples, both proportional assist ventilation (PAV) and NAVA compared to baseline ventilation resulted in improvement in the “OI”, but there was no significant difference in the “OI” on PAV compared to NAVA
Summary
Mechanical ventilation can be live-saving in the neonatal period but is associated with complications such as bronchopulmonary dysplasia (BPD) and chronic respiratory morbidity [1]. Modes of ventilation that allow synchrony both of the timing and the level of support to the infant’s respiratory effort have been developed. Both proportional assist ventilation (PAV) and neurally adjusted ventilator assist (NAVA) provide support synchronised throughout the respiratory cycle. PAV delivers support proportional to the infant’s respiratory effort. The support delivered by NAVA is proportional to the electrical activity of the diaphragm, which is reflective of the neural respiratory drive. The Edi is the signal used to trigger the ventilator and determines the level of support. The clinician can adjust the NAVA level to increase or decrease the amount of pressure delivered per microvolt of Edi detected [3, 4]
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