Document Detail


Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants.
MedLine Citation:
PMID:  19218884     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Neurally adjusted ventilatory assist (NAVA), a mode of mechanical ventilation controlled by diaphragmatic electrical activity (EAdi), may improve patient-ventilator interaction. We examined patient-ventilator interaction by comparing EAdi to ventilator pressure during conventional ventilation (CV) and NAVA delivered invasively and non-invasively. Seven intubated infants [birth weight 936 g (range, 676-1266 g); gestational age 26 wk (range, 25-29)] were studied before and after extubation, initially during CV and then NAVA. NAVA-intubated and NAVA-extubated demonstrated similar delays between onset of EAdi and onset of ventilator pressure of 74 +/- 17 and 72 +/- 23 ms (p = 0.698), respectively. During CV, the mean trigger delays were not different from NAVA, however 13 +/- 8.5% of ventilator breaths were triggered on average 59 +/- 27 ms before onset of EAdi. There was no difference in off-cycling delays between NAVA-intubated and extubated (32 +/- 34 versus 28 +/- 11 ms). CV cycled-off before NAVA (120 +/- 66 ms prior, p < 0.001). During NAVA, EAdi and ventilator pressure were correlated [mean determination coefficient (NAVA-intubated 0.8 +/- 0.06 and NAVA-extubated 0.73 +/- 0.22)]. Pressure delivery during conventional ventilation was not correlated to EAdi. Neural expiratory time was longer (p = 0.044), and respiratory rate was lower (p = 0.004) during NAVA. We conclude that in low birth weight infants, NAVA can improve patient-ventilator interaction, even in the presence of large leaks.
Authors:
Jennifer Beck; Maureen Reilly; Giacomo Grasselli; Lucia Mirabella; Arthur S Slutsky; Michael S Dunn; Christer Sinderby
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pediatric research     Volume:  65     ISSN:  1530-0447     ISO Abbreviation:  Pediatr. Res.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-20     Completed Date:  2009-08-17     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  0100714     Medline TA:  Pediatr Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  663-8     Citation Subset:  IM    
Affiliation:
Keenan Research Centre, St Michael's Hospital, Toronto, Ontario, Canada. beckj@smh.toronto.on.ca
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MeSH Terms
Descriptor/Qualifier:
Diaphragm* / innervation,  physiology
Gestational Age
Humans
Infant, Low Birth Weight*
Infant, Newborn
Infant, Premature
Intubation, Intratracheal / methods
Premature Birth
Respiration, Artificial / methods*
Respiratory Mechanics
Signal Processing, Computer-Assisted*
Grant Support
ID/Acronym/Agency:
1 R21 HD45047-01/HD/NICHD NIH HHS; R21 HD045047-01/HD/NICHD NIH HHS
Comments/Corrections

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