A randomized controlled trial comparing non-invasive ventilation delivered using neurally adjusted ventilator assist (NAVA) or adaptive support ventilation (ASV) in patients with acute exacerbation of chronic obstructive pulmonary disease

• Published in: Journal of critical care Vol. 75; p. 154250
• Main Authors: Chhabria, Bharath A., Prasad, Kuruswamy Thurai, Dhooria, Sahajal, Muthu, Valliappan, Aggarwal, Ashutosh Nath, Agarwal, Ritesh, Gandra, Raghava Rao, Sehgal, Inderpaul Singh
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2023; Elsevier Limited
• Subjects: Aged; BIPAP; Blood pressure; Catheters; Chronic obstructive pulmonary disease; Clinical trials; Coma; Disease prevention; Dyspnea; Esophagus; Female; Heart rate; Humans; Hypotension; Interactive Ventilatory Support; Intubation; Male; Mechanical ventilation; Middle Aged; Mortality; NAVA; NIV; Noninvasive Ventilation; Ostomy; PSV; Pulmonary Disease, Chronic Obstructive - therapy; Pulse oximetry; Respiration, Artificial; Respiratory failure; Surgery; Ventilators; Ventilators, Mechanical; Weaning; PSV; NIV; NAVA; Respiratory failure; BIPAP; Mechanical ventilation
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2022.154250

No study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In this randomized controlled trial, we compared NAVA-NIV with ASV-NIV for delivering NIV in consecutive subjects with AECOPD. The primary outcome was NIV failure rate (invasive mechanical ventilation). The key secondary outcomes were number of NIV manipulations, asynchrony index, and 90-day mortality. We enrolled 76 subjects (NAVA-NIV, n = 36, ASV-NIV, n = 40; 74% males) with a mean ± SD age of 61.4 ± 8.2 years. We found no difference in NIV failure rates between the two arms (NAVA-NIV vs. ASV-NIV; 8/36 [22.2%] vs. 8/40 [20%]; p = 0.83). The median physician manipulations for NIV were significantly less in the ASV-NIV arm than in the NAVA-NIV arm (2 [0.8–4] vs. 3 [2–5]; p= 0.014) during the initial 24-h. We found no difference in median asynchrony index (NAVA-NIV vs. ASV-NIV, 16.6% vs. 16.4%, p = 0.5) and 90-day mortality (22.2% vs. 17.5%, p = 0.67). The use of NAVA-NIV was not superior to ASV-NIV in reducing NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV had similar asynchrony index and 90-day mortality. www.clinicaltrials.gov (NCT04414891). Study question: Is NAVA-NIV associated with fewer NIV failure (need for airway intubation) than ASV-NIV in AECOPD due to superior patient-ventilator interactions? Results: We found no difference in NIV failure rates between the two arms. The asynchrony index and 90-day mortality was similar in both the study arm. ASV-NIV however, required fewer physician manipulations. Interpretation: The use of NAVA-NIV compared to ASV-NIV did not reduce NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV were comparable in patient-ventilator interactions. [Display omitted] •No previous study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in managing subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).•This paper contributes to our knowledge?•The use of NAVA-NIV compared to ASV-NIV did not reduce NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV were comparable in patient-ventilator interactions.•However, ASV-NIV required lesser physician NIV adjustments during the initial 24 h of NIV use. Importantly, both NAVA and ASV were safe even when used as NIV for a prolonged duration.