Comparing Noninvasive Ventilation Delivered Using Neurally-Adjusted Ventilatory Assist or Pressure Support in Acute Respiratory Failure

Abstract

Background: The use of neurally-adjusted ventilatory assist (NAVA) during noninvasive ventilation (NIV) results in better patient-ventilator interaction. Whether this improves clinical outcomes lacks dedicated study.

Methods: In this randomized controlled trial, we compared NAVA with PSV for delivering NIV in consecutive subjects with de novo acute respiratory failure. The primary outcomes were NIV failure rates and 28-d mortality. The secondary outcomes were asynchrony index, NIV-related complications, and others.

Results: We enrolled 100 subjects (50 subjects each for NAVA and PSV, 60% male) with a mean ± SD age of 56.7 ± 12 y. There was no difference in NIV failure rates (30% vs 32%, P = .83) and 28-d mortality rates (18% vs 34%, P = .07) between the NAVA and PSV arms, respectively. The median asynchrony index was significantly lower with NAVA (6.7 vs 44.8, P < .001). The use of NAVA significantly reduced NIV-related complications (32% vs 58%, P = .01). In a post hoc analysis, the use of NAVA significantly reduced the 28-d mortality in subjects with COPD exacerbation.

Conclusions: The use of NAVA during NIV did not improve NIV failure rate or 28-d mortality in subjects with acute respiratory failure. However, patient-ventilator asynchrony and NIV-related complications were reduced with NAVA.

Trial registry: www.clinicaltrials.gov (NCT03271671).

Keywords: bi-level positive airway pressure; mechanical ventilation; neurally adjusted ventilatory assist; noninvasive ventilation; pressure support ventilation; respiratory failure.

Conflict of interest statement

The authors have disclosed no conflicts of interest.

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