Implementation of noninvasive neurally adjusted ventilatory assist in pediatric acute respiratory failure: a controlled before-after quality improvement study

• Published in: Journal of Anesthesia, Analgesia and Critical Care (Online) Vol. 1; no. 1; p. 1
• Main Authors: Chidini, Giovanna, De Luca, Daniele, Calderini, Edoardo, Catenacci, Stefano Scalia, Marchesi, Tiziana, Langer, Thomas, Gregoretti, Cesare, Conti, Giorgio
• Format: Journal Article
• Language: English
• Published: England Springer Nature B.V 01.09.2021; BioMed Central; BMC
• Subjects: Acute respiratory failure; Aging; Catheters; Chest tubes; Children; Diaphragm (Anatomy); Intubation; Length of stay; Life Sciences; Neurally adjusted ventilatory assist; Noninvasive ventilation; Nosocomial infections; Original; Oxygen saturation; Oxygen therapy; Patients; Pediatrics; Physiology; Pneumonia; Quality improvement; Respiratory failure; Software; Ventilators; Viral infections; Sweden; Acute respiratory failure; Noninvasive ventilation; Children; Neurally adjusted ventilatory assist
• ISSN: 2731-3786; 2731-3786
• DOI: 10.1186/s44158-021-00005-8

Pediatric noninvasive neurally adjusted ventilatory assist (NIV-NAVA) has been shown to improve patient-ventilator interaction but no data on clinical outcomes are available. Aim of this study was to compare NIV-NAVA with noninvasive pressure support (NIV-PS) in children with acute hypoxemic respiratory failure (AHRF), in a single-center before-after study. A cohort of thirty-four NIV-PS patients (before group) admitted to our PICU within the 2 years prior NAVA introduction was compared with a cohort of thirty children treated with NIV-NAVA during implementation phase (after group). The primary end-point was intubation rate between groups. Days on mechanical ventilation, number of invasive devices, nosocomial infections, PICU/hospital length of stay (LOS), and physiological parameters at 2 and 24 h after admission were considered. Intubation rate was lower in the NIV-NAVA group as compared to the NIV-PS group (p = 0.006). Patients treated with NIV-NAVA required fewer invasive devices (p = 0.032) and had lower incidence of ventilator-acquired pneumonia (p = 0.004) and shorter PICU (p = 0.032) and hospital LOS (p = 0.013). At 2 h, NIV-NAVA compared with NIV-PS resulted in higher paO :FIO (p = 0.017), lower paCO (p = 0.002), RR (p = 0.026), and HR (p = 0.009). Early NIV-NAVA vs NIV-PS was associated to lower intubation rate and shorter PICU and hospital LOS. Further studies are needed in order to confirm these preliminary data.