| Daily titration of neurally adjusted ventilatory assist using the diaphragm electrical activity. | |
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MedLine Citation:
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PMID: 21424827 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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PURPOSE: To determine the feasibility of daily titration of the neurally adjusted ventilatory assist (NAVA) level in relation to the maximal diaphragmatic electrical activity (EAdi(maxSBT)) measured during a spontaneous breathing trial (SBT) during pressure support ventilation (PSV). METHODS: The study included 15 consecutive patients in whom mechanical ventilation weaning was initiated with the NAVA mode. EAdi(maxSBT) was determined daily during an SBT using PSV with 7 cmH(2)O of inspiratory pressure and no positive end-expiratory pressure (PEEP). If the SBT was unsuccessful, NAVA was used and the level was then adjusted to obtain an EAdi of ~60% of the EAdi(maxSBT). Arterial blood gas analyses were performed 20 min after each change in NAVA level. RESULTS: Three patients were dropped from the study at day 4 because of worsening of their sickness. The median duration of NAVA ventilation was 4.5 days (IQR 3-6.5). From day 1 to extubation, EAdi(maxSBT) and EAdi increased significantly from 16.6 (9.6) to 21.7 (10.3) μV (P = 0.013) and from 10.0 (5.5) to 15.1 (9.2) μV (P = 0.026), respectively. The pressure delivered significantly decreased from 20 (8) to 10 (5) cmH(2)O (P = 0.003). Conversely, tidal volume, carbon dioxide tension, and pH values remained unchanged during the same period. CONCLUSION: These results suggest that daily titration of NAVA level with an electrical goal of ~60% EAdi(maxSBT) is feasible and well tolerated. The respiratory mechanics improvement and increase in respiratory drive allowed for a daily reduction of the NAVA level while preserving breathing, oxygenation, and alveolar ventilation until extubation. |
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Authors:
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Hadrien Rozé; Abdelghani Lafrikh; Virginie Perrier; Arnaud Germain; Antoine Dewitte; Francis Gomez; Gérard Janvier; Alexandre Ouattara |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-22 |
Journal Detail:
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Title: Intensive care medicine Volume: - ISSN: 1432-1238 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-22 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Anesthesia and Intensive Care II, Thoracic Intensive Care Unit, Centre Hospitalier Universitaire (CHU) Bordeaux, Groupe Sud, Pessac, Université Victor Segalen Bordeaux II, Bordeaux, France, hadrien.roze@chu-bordeaux.fr. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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