Neurally adjusted ventilatory assist improves patient–ventilator interaction

• Published in: Intensive care medicine Vol. 37; no. 2; pp. 263 - 271
• Main Authors: Piquilloud, Lise, Vignaux, Laurence, Bialais, Emilie, Roeseler, Jean, Sottiaux, Thierry, Laterre, Pierre-François, Jolliet, Philippe, Tassaux, Didier
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.02.2011; Springer; Springer Nature B.V
• Subjects: Acute respiratory distress syndrome; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Comparative analysis; Critical care; Critical Care Medicine; Diaphragm - innervation; Diaphragm - physiology; Electromyography; Emergency and intensive respiratory care; Emergency Medicine; Equipment Design; Female; Humans; Intensive; Intensive care; Intensive care medicine; Intermittent Positive-Pressure Ventilation - instrumentation; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Original; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Respiration, Artificial - methods; Respiratory failure; Respiratory Insufficiency - therapy; Respiratory Mechanics - physiology; Signal Processing, Computer-Assisted; Software; Ventilators; Belgium; Switzerland; Sweden; Pressure support; Partial ventilatory assist; Neurally adjusted ventilatory assist; Patient–ventilator interaction; Mechanical ventilation; Human; Ventilator; Intensive care; Patient-ventilator interaction; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-2052-9

Purpose To determine if, compared with pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces trigger delay, inspiratory time in excess, and the number of patient–ventilator asynchronies in intubated patients. Methods Prospective interventional study in spontaneously breathing patients intubated for acute respiratory failure. Three consecutive periods of ventilation were applied: (1) PS1, (2) NAVA, (3) PS2. Airway pressure, flow, and transesophageal diaphragmatic electromyography were continuously recorded. Results All results are reported as median (interquartile range, IQR). Twenty-two patients were included, 36.4% (8/22) having obstructive pulmonary disease. NAVA reduced trigger delay (ms): NAVA, 69 (57–85); PS1, 178 (139–245); PS2, 199 (135–256). NAVA improved expiratory synchrony: inspiratory time in excess (ms): NAVA, 126 (111–136); PS1, 204 (117–345); PS2, 220 (127–366). Total asynchrony events were reduced with NAVA (events/min): NAVA, 1.21 (0.54–3.36); PS1, 3.15 (1.18–6.40); PS2, 3.04 (1.22–5.31). The number of patients with asynchrony index (AI) >10% was reduced by 50% with NAVA. In contrast to PS, no ineffective effort or late cycling was observed with NAVA. There was less premature cycling with NAVA (events/min): NAVA, 0.00 (0.00–0.00); PS1, 0.14 (0.00–0.41); PS2, 0.00 (0.00–0.48). More double triggering was seen with NAVA, 0.78 (0.46–2.42); PS1, 0.00 (0.00–0.04); PS2, 0.00 (0.00–0.00). Conclusions Compared with standard PS, NAVA can improve patient–ventilator synchrony in intubated spontaneously breathing intensive care patients. Further studies should aim to determine the clinical impact of this improved synchrony.