Document Detail

Neurally adjusted ventilatory assist vs pressure support ventilation for noninvasive ventilation during acute respiratory failure: a crossover physiologic study.
MedLine Citation:
PMID:  22661448     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patient-ventilator asynchrony is common during noninvasive ventilation (NIV) with pressure support ventilation (PSV). We examined the effect of neurally adjusted ventilatory assist (NAVA) delivered through a facemask on synchronization in patients with acute respiratory failure (ARF).
METHODS: This was a prospective, physiologic, crossover study of 13 patients with ARF (median Pa(O(2))/F(IO(2)), 196 [interquartile range (IQR), 142-225]) given two 30-min trials of NIV with PSV and NAVA in random order. Diaphragm electrical activity (EAdi), neural inspiratory time (T(In)), trigger delay (Td), asynchrony index (AI), arterial blood gas levels, and patient discomfort were recorded.
RESULTS: There were significantly fewer asynchrony events during NAVA than during PSV (10 [IQR, 5-14] events vs 17 [IQR, 8-24] events, P = .017), and the occurrence of severe asynchrony (AI > 10%) was also less under NAVA (P = .027). Ineffective efforts and delayed cycling were significantly less with NAVA (P < .05 for both). NAVA was also associated with reduced Td (0 [IQR, 0-30] milliseconds vs 90 [IQR, 30-130] milliseconds, P < .001) and inspiratory time in excess (10 [IQR, 0-28] milliseconds vs 125 [IQR, 20-312] milliseconds, P < .001), but T(In) was similar under PSV and NAVA. The EAdi signal to its maximal value was higher during NAVA than during PSV ( P = .017). There were no significant differences in arterial blood gases or patient discomfort under PSV and NAVA.
CONCLUSION: In view of specific experimental conditions, our comparison of PSV and NAVA indicated that NAVA significantly reduced severe patient-ventilator asynchrony and resulted in similar improvements in gas exchange during NIV for ARF.
Pierre-Marie Bertrand; Emmanuel Futier; Yannael Coisel; Stefan Matecki; Samir Jaber; Jean-Michel Constantin
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Chest     Volume:  143     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-02-08     Completed Date:  2013-04-02     Revised Date:  2013-05-10    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  30-6     Citation Subset:  AIM; IM    
Department of Anesthesiology and Critical Care, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
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MeSH Terms
Aged, 80 and over
Cross-Over Studies
Interactive Ventilatory Support / methods*
Middle Aged
Noninvasive Ventilation / methods*
Positive-Pressure Respiration / methods*
Prospective Studies
Respiratory Insufficiency / therapy*
Comment In:
Chest. 2013 Apr;143(4):1181-2   [PMID:  23546497 ]
Chest. 2013 Apr;143(4):1181   [PMID:  23546496 ]

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