Neurally adjusted ventilatory assist (NAVA), a mode of mechanical ventilation controlled by diaphragmatic electrical activity (EAdi), may improve patient-ventilator interaction. We examined patient-ventilator interaction by comparing EAdi to ventilator pressure during conventional ventilation (CV) and NAVA delivered invasively and non-invasively. Seven intubated infants [birth weight 936 g (range, 676-1266 g); gestational age 26 wk (range, 25-29)] were studied before and after extubation, initially during CV and then NAVA. NAVA-intubated and NAVA-extubated demonstrated similar delays between onset of EAdi and onset of ventilator pressure of 74 ± 17 and 72 ± 23 ms (p = 0.698), respectively. During CV, the mean trigger delays were not different from NAVA, however 13 ± 8.5% of ventilator breaths were triggered on average 59 ± 27 ms before onset of EAdi. There was no difference in off-cycling delays between NAVA-intubated and extubated (32 ± 34 versus 28 ± 11 ms). CV cycled-off before NAVA (120 ± 66 ms prior, p < 0.001). During NAVA, EAdi and ventilator pressure were correlated [mean determination coefficient (NAVA-intubated 0.8 ± 0.06 and NAVA-extubated 0.73 ± 0.22)]. Pressure delivery during conventional ventilation was not correlated to EAdi. Neural expiratory time was longer (p = 0.044), and respiratory rate was lower (p = 0.004) during NAVA. We conclude that in low birth weight infants, NAVA can improve patient-ventilator interaction, even in the presence of large leaks.
Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants / J. Beck, M. Reilly, G. Grasselli, L. Mirabella, A.S. Slutsky, M.S. Dunn, C. Sinderby. - In: PEDIATRIC RESEARCH. - ISSN 0031-3998. - 65:6(2009), pp. 663-668. (Intervento presentato al convegno Annual Meeting of the Pediatric-Academic-Societies/Society-of-Pediatric-Research tenutosi a Toronto nel 2007) [10.1203/PDR.0b013e31819e72ab].
Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants
G. Grasselli;
2009
Abstract
Neurally adjusted ventilatory assist (NAVA), a mode of mechanical ventilation controlled by diaphragmatic electrical activity (EAdi), may improve patient-ventilator interaction. We examined patient-ventilator interaction by comparing EAdi to ventilator pressure during conventional ventilation (CV) and NAVA delivered invasively and non-invasively. Seven intubated infants [birth weight 936 g (range, 676-1266 g); gestational age 26 wk (range, 25-29)] were studied before and after extubation, initially during CV and then NAVA. NAVA-intubated and NAVA-extubated demonstrated similar delays between onset of EAdi and onset of ventilator pressure of 74 ± 17 and 72 ± 23 ms (p = 0.698), respectively. During CV, the mean trigger delays were not different from NAVA, however 13 ± 8.5% of ventilator breaths were triggered on average 59 ± 27 ms before onset of EAdi. There was no difference in off-cycling delays between NAVA-intubated and extubated (32 ± 34 versus 28 ± 11 ms). CV cycled-off before NAVA (120 ± 66 ms prior, p < 0.001). During NAVA, EAdi and ventilator pressure were correlated [mean determination coefficient (NAVA-intubated 0.8 ± 0.06 and NAVA-extubated 0.73 ± 0.22)]. Pressure delivery during conventional ventilation was not correlated to EAdi. Neural expiratory time was longer (p = 0.044), and respiratory rate was lower (p = 0.004) during NAVA. We conclude that in low birth weight infants, NAVA can improve patient-ventilator interaction, even in the presence of large leaks.File | Dimensione | Formato | |
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