Evaluating peak inspiratory pressures and tidal volume in premature neonates on NAVA ventilation

• Published in: European journal of pediatrics Vol. 180; no. 1; pp. 167 - 175
• Main Authors: Protain, Alison P., Firestone, Kimberly S., McNinch, Neil L., Stein, Howard M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2021; Springer Nature B.V
• Subjects: Feedback; Humans; Infant, Newborn; Interactive Ventilatory Support; Mechanical ventilation; Medicine; Medicine & Public Health; Neonates; Newborn babies; Original; Original Article; Pediatrics; Positive-Pressure Respiration; Pressure; Respiration; Respiratory Function Tests; Retrospective Studies; Statistical analysis; Tidal Volume; Ventilation; Ventilators; Peak pressure; Premature neonates; Neurally adjusted ventilatory assist (NAVA); Ventilatory induced lung injury; Tidal volume
• ISSN: 0340-6199; 1432-1076; 1432-1076
• DOI: 10.1007/s00431-020-03728-y

Neurally adjusted ventilatory assist (NAVA) ventilation allows patients to determine their peak inspiratory pressure and tidal volume on a breath-by-breath basis. Apprehension exists about premature neonates’ ability to self-regulate breath size. This study describes peak pressure and tidal volume distribution of neonates on NAVA and non-invasive NAVA. This is a retrospective study of stored ventilator data with exploratory analysis. Summary statistics were calculated. Distributional assessment of peak pressure and tidal volume were evaluated, overall and per NAVA level. Over 1 million breaths were evaluated from 56 subjects. Mean peak pressure was 16.4 ± 6.4 in the NAVA group, and 15.8 ± 6.4 in the NIV-NAVA group ( t test, p  < 0.001). Mean tidal volume was 3.5 ± 2.7 ml/kg. Conclusion :In neonates on NAVA, most pressures and volumes were within or lower than recommended ranges with pressure-limited or volume-guarantee ventilation. What is known: • Limiting peak inspiratory pressures or tidal volumes are the main strategies to minimize ventilator-induced lung injury in neonates. Neurally adjusted ventilatory assist allows neonates to regulate their own peak inspiratory pressures and tidal volumes on a breath-to-breath basis using neural feedback. What is new: • When neonates chose the size of their breaths based on neural feedback, the majority of peak inspiratory pressures and tidal volumes were within or lower than the recommended peak inspiratory pressure or tidal volume ranges with pressure-limited or volume guarantee ventilation.