| Neurally adjusted ventilatory assist increases respiratory variability and complexity in acute respiratory failure. | |
| | |
MedLine Citation:
|
PMID: 20179505 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is a partial ventilatory support mode where positive pressure is provided in relation to diaphragmatic electrical activity (EAdi). Central inspiratory activity is normally not monotonous, but it demonstrates short-term variability and complexity. The authors reasoned that NAVA should produce a more "natural" or variable breathing pattern than other modes. This study compared respiratory variability and complexity during pressure support ventilation (PSV) and NAVA. METHODS: Flow and EAdi were recorded during routine PSV (tidal volume approximately 6-8 ml/kg) and four NAVA levels (1-4 cm H2O/microVEAdi) in 12 intubated patients. Breath-by-breath variability of flow and EAdi-related variables was quantified by the coefficient of variation (CV) and autocorrelation analysis. Complexity of flow and EAdi was described using noise titration, largest Lyapunov exponent, Kolmogorov-Sinai entropy, and three-dimensional phase portraits. RESULTS: Switching from PSV to NAVA increased the CV and decreased the autocorrelation for most flow-related variables in a dose-dependent manner (P < 0.05, partial eta for the CV of mean inspiratory flow 0.642). The changes were less marked for EAdi. A positive noise limit was consistently found for flow and EAdi. Largest Lyapunov exponent and Kolmogorov-Sinai entropy for flow were greater during NAVA than PSV and increased with NAVA level (P < 0.05, partial eta 0.334 and 0.312, respectively). Largest Lyapunov exponent and Kolmogorov-Sinai entropy for EAdi were not influenced by ventilator mode. CONCLUSIONS: Compared with PSV, NAVA increases the breathing pattern variability and complexity of flow, whereas the complexity of EAdi is unchanged. Whether this improves clinical outcomes remains to be determined. |
| | |
Authors:
|
Matthieu Schmidt; Alexandre Demoule; Christophe Cracco; Alexandre Gharbi; Marie-No?lle Fiamma; Christian Straus; Alexandre Duguet; Stewart B Gottfried; Thomas Similowski |
Related Documents
:
|
7249705 - The maximum expiratory flow-volume curve with air and a low-density gas misture. an ana... 11503285 - Awake respiratory function in patients with the obstructive sleep apnoea syndrome. 1394405 - Normal pulmonary function in botswana. 2080765 - Airway diameter determines flow-resistance and sensitivity to contractile mediators in ... 9247695 - Effect of transportation on lower respiratory tract contamination and peripheral blood ... 3849375 - A mathematical model and computer program for adriamycin distribution and elimination. |
Publication Detail:
|
Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Anesthesiology Volume: 112 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2010 Mar |
Date Detail:
|
Created Date: 2010-02-24 Completed Date: 2010-03-30 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
|
Languages: eng Pagination: 670-81 Citation Subset: AIM; IM |
Affiliation:
|
Assistance Publique-H?pitaux de Paris, Service de Pneumologie et R?animation, Groupe Hospitalier Piti?-Salp?tri?re, and Universit? Paris 6-Pierre et Marie Curie, Paris, France. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Air Pressure Blood Gas Analysis Data Interpretation, Statistical Diaphragm / physiology Dose-Response Relationship, Drug Electromyography* Entropy Esophagus / innervation, physiology Female Humans Intensive Care Male Middle Aged Respiration, Artificial* Respiratory Distress Syndrome, Adult / physiopathology*, therapy* Respiratory Mechanics / physiology* Ventilator Weaning |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Mild endotoxemia during mechanical ventilation produces spatially heterogeneous pulmonary neutrophil...
Next Document: Lung Ventilation and Perfusion in Prone and Supine Postures with Reference to Anesthetized and Mecha...