Neurally adjusted ventilatory assist versus pressure support ventilation in patient-ventilator interaction and clinical outcomes: a meta-analysis of clinical trials

Abstract

Background: The objective of this study was to conduct a meta-analysis comparing neurally adjusted ventilatory assist (NAVA) with pressure support ventilation (PSV) in adult ventilated patients with patient-ventilator interaction and clinical outcomes.

Methods: The PubMed, the Web of Science, Scopus, and Medline were searched for appropriate clinical trials (CTs) comparing NAVA with PSV for the adult ventilated patients. RevMan 5.3 was performed for comparing NAVA with PSV in asynchrony index (AI), ineffective efforts, auto-triggering, double asynchrony, premature asynchrony, breathing pattern (Peak airway pressure (Pawpeek), mean airway pressure (Pawmean), tidal volume (VT, mL/kg), minute volume (MV), respiratory muscle unloading (peak electricity of diaphragm (EAdipeak), P 0.1, VT/EAdi), clinical outcomes (ICU mortality, duration of ventilation days, ICU stay time, hospital stay time).

Results: Our meta-analysis included 12 studies involving a total of 331 adult ventilated patients, AI was significantly lower in NAVA group [mean difference (MD) -12.82, 95% confidence interval (CI): -21.20 to -4.44, I2=88%], and using subgroup analysis, grouped by mechanical ventilation, the results showed that NAVA also had lower AI than PSV (Mechanical ventilation, MD -9.52, 95% CI: -17.85 to -1.20, I2=87%), (Non-invasive ventilation (NIV), MD -24.55, 95% CI: -35.40 to -13.70, I2=0%). NAVA was significantly lower than the PSV in auto-triggering (MD -0.28, 95% CI: -0.51 to -0.05, I2=10%), and premature triggering (MD -2.49, 95% CI: -3.77 to -1.21, I2=29%). There were no significant differences in double triggering, ineffective efforts, breathing pattern (Pawmean, Pawpeak, VT, MV), and respiratory muscle unloading (EAdipeak, P 0.1, VT/EAdi). For clinical outcomes, NAVA was significantly lower than the PSV (MD -2.82, 95% CI: -5.55 to -0.08, I2=0%) in the duration of ventilation, but two groups did not show significant differences in ICU mortality, ICU stay time, and hospital stay time.

Conclusions: NAVA is more beneficial in patient-ventilator interaction than PSV, and could decrease the duration of ventilation.

Keywords: Neurally adjusted ventilatory assist (NAVA); patient-ventilator interaction; pressure support ventilation (PSV).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Flow diagram of choosing the appropriated articles.

Figure 2

Risk of bias graph.

Figure 3

Risk of bias summary.

Figure 4

Subgroup analysis of divided by whether mechanical ventilation of asynchrony index.

Figure 5

Subgroup analysis of divided by randomization of asynchrony index.

Figure 6

Subgroup analysis of divided by Jadad scores of studies.

Figure 7

Ineffective efforts of patients.

Figure 8

Auto triggering of patients.

Figure 9

Double triggering of patients.

Figure 10

Premature triggering of patients.

Figure 11

ICU mortality of patients.

Figure 12

Duration of ventilation of patients.

Figure 13

ICU stay time of patients.

Figure 14

Hospital stay time of patients.

Figure 15

Funnel plot of AI comparing NAVA with PSV. AI, asynchrony index; NAVA, neurally adjusted ventilatory assist; PSA, pressure support ventilation.

Figure S1

Ventilation volume/kg.

Figure S2

Mean paw.

Figure S3

Peak paw.

Figure S4

Minute ventilation volume.

Figure S5

Peak Edi.

Figure S6

P 0.1.

Figure S7

VT/Edi.