Document Detail


Neurally adjusted ventilatory assist in critically ill postoperative patients: a crossover randomized study.
MedLine Citation:
PMID:  20823760     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to the electrical activity of the diaphragm. This study aimed to compare the ventilatory and gas exchange effects between NAVA and pressure support ventilation (PSV) during the weaning phase of critically ill patients who required mechanical ventilation subsequent to surgery. METHODS: Fifteen patients, the majority of whom underwent abdominal surgery, were enrolled. They were ventilated with PSV and NAVA for 24 h each in a randomized crossover order. The ventilatory parameters and gas exchange effects produced by the two ventilation modes were compared. The variability of the ventilatory parameters was also evaluated by the coefficient of variation (SD to mean ratio). RESULTS: Two patients failed to shift to NAVA because of postoperative bilateral diaphragmatic paralysis, and one patient interrupted the study because of worsening of his sickness. In the other 12 cases, the 48 h of the study protocol were completed, using both ventilation modes, with no signs of intolerance or complications. The Pao2/Fio2 (mean ± SD) ratio in NAVA was significantly higher than with PSV (264 ± 71 vs. 230 ± 75 mmHg, P < 0.05). Paco2 did not differ significantly between the two modes. The tidal volume (median [interquartile range]) with NAVA was significantly lower than with PSV (7.0 [6.4-8.6] vs. 6.5 [6.3-7.4] ml/kg predicted body weight, P < 0.05).Variability of insufflation airway pressure, tidal volume, and minute ventilation were significantly higher with NAVA than with PSV. Electrical activity of the diaphragm variability was significantly lower with NAVA than with PSV. CONCLUSIONS: Compared with PSV, respiratory parameter variability was greater with NAVA, probably leading in part to the significant improvement in patient oxygenation.
Authors:
Yannael Coisel; Gerald Chanques; Boris Jung; Jean-Michel Constantin; Xavier Capdevila; Stefan Matecki; Salvatore Grasso; Samir Jaber
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  113     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-24     Completed Date:  2010-10-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  925-35     Citation Subset:  AIM; IM    
Affiliation:
Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Critical Care / methods*
Critical Illness*
Cross-Over Studies
Electrocardiography
Female
Humans
Male
Middle Aged
Monitoring, Physiologic
Oxygen Consumption / physiology
Postoperative Complications / physiopathology
Prospective Studies
Pulmonary Gas Exchange
Respiration, Artificial / methods*
Respiratory Mechanics / physiology
Ventilator Weaning

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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