Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction during non-invasive ventilation delivered by face mask

Lise Piquilloud, Didier Tassaux, Emilie Bialais, Bernard Lambermont, Thierry Sottiaux, Jean Roeseler, Pierre-François Laterre, Philippe Jolliet, Jean-Pierre Revelly, Lise Piquilloud, Didier Tassaux, Emilie Bialais, Bernard Lambermont, Thierry Sottiaux, Jean Roeseler, Pierre-François Laterre, Philippe Jolliet, Jean-Pierre Revelly

Abstract

Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask.

Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T(d)), the patient's neural inspiratory time (T(in)), ventilator pressurization duration (T(iv)), inspiratory time in excess (T(iex)), number of asynchrony events per minute and asynchrony index (AI) were determined.

Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T(d) was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T(iex) value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO(2) and PaCO(2) were not different between ventilatory modes.

Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T(d) and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

References

    1. Intensive Care Med. 2009 May;35(5):840-6
    1. Intensive Care Med. 2008 Sep;34(9):1615-23
    1. Am J Respir Crit Care Med. 2003 Dec 15;168(12):1438-44
    1. Chest. 2012 Aug;142(2):367-376
    1. Crit Care Med. 2010 Sep;38(9):1830-7
    1. Br J Anaesth. 2003 Jul;91(1):106-19
    1. Intensive Care Med. 2008 Aug;34(8):1477-86
    1. Intensive Care Med. 2007 Aug;33(8):1444-51
    1. Am J Respir Crit Care Med. 1998 Feb;157(2):428-34
    1. Intensive Care Med. 2010 Dec;36(12):2053-9
    1. JAMA. 2002 Jan 16;287(3):345-55
    1. Eur Respir J. 1997 Jan;10(1):177-83
    1. Am J Respir Crit Care Med. 2006 Jan 15;173(2):164-70
    1. Pediatr Res. 2009 Jun;65(6):663-8
    1. Respir Physiol. 1975 Mar;23(2):181-99
    1. Am J Respir Crit Care Med. 2001 Mar;163(4):874-80
    1. Am J Respir Crit Care Med. 2005 Nov 15;172(10):1283-9
    1. Intensive Care Med. 2006 Nov;32(11):1747-55
    1. Am J Respir Crit Care Med. 2001 Aug 1;164(3):419-24
    1. Pediatr Res. 2007 Mar;61(3):289-94
    1. N Engl J Med. 1995 Sep 28;333(13):817-22
    1. Intensive Care Med. 2009 Oct;35(10):1809-14
    1. Intensive Care Med. 2011 Dec;37(12):1943-50
    1. Crit Care Med. 2010 Feb;38(2):518-26
    1. Intensive Care Med. 2008 Nov;34(11):2010-8
    1. Nat Med. 1999 Dec;5(12):1433-6
    1. Intensive Care Med. 2011 Feb;37(2):263-71
    1. Chest. 1997 Dec;112(6):1592-9
    1. Eur Respir J. 2004 Feb;23(2):314-20
    1. J Appl Physiol (1985). 2000 Jun;88(6):2143-50
    1. Intensive Care Med. 2006 Oct;32(10):1515-22

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