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Backgrounds  Pediatric noninvasive neurally adjusted ventilatory assist (NIV-NAVA) has been shown to improve patient-ventilator interaction but no data on clinical outcomes are available. Aim of this study was to compare NIV-NAVA with noninvasive pressure support (NIV-PS) in children with acute hypoxemic respiratory failure (AHRF), in a single-center before-after study. A cohort of thirty-four NIV-PS patients (before group) admitted to our PICU within the 2 years prior NAVA introduction was compared with a cohort of thirty children treated with NIV-NAVA during implementation phase (after group). The primary end-point was intubation rate between groups. Days on mechanical ventilation, number of invasive devices, nosocomial infections, PICU/hospital length of stay (LOS), and physiological parameters at 2 and 24 h after admission were considered.    Results  Intubation rate was lower in the NIV-NAVA group as compared to the NIV-PS group ( p  = 0.006). Patients treated with NIV-NAVA required fewer invasive devices ( p  = 0.032) and had lower incidence of ventilator-acquired pneumonia ( p  = 0.004) and shorter PICU ( p  = 0.032) and hospital LOS ( p  = 0.013). At 2 h, NIV-NAVA compared with NIV-PS resulted in higher paO 2 :FIO 2  ( p  = 0.017), lower paCO 2  ( p  = 0.002), RR ( p  = 0.026), and HR ( p  = 0.009).    Conclusions  Early NIV-NAVA vs NIV-PS was associated to lower intubation rate and shorter PICU and hospital LOS. Further studies are needed in order to confirm these preliminary data.

journal of anesthesia, analgesia and critical care

Implementation of noninvasive neurally adjusted ventilatory assist in pediatric acute respiratory failure: a controlled before-after quality improvement study