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Neurally adjusted ventilator assist (NAVA) reduces asynchrony during non‐invasive ventilation for severe bronchiolitis
Author(s) -
Baudin Florent,
Pouyau Robin,
CourAndlauer Fleur,
Berthiller Julien,
Robert Dominique,
Javouhey Etienne
Publication year - 2015
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23139
Subject(s) - medicine , bronchiolitis , asynchrony (computer programming) , ventilation (architecture) , respiratory system , peak inspiratory pressure , anesthesia , respiratory rate , cardiology , heart rate , blood pressure , tidal volume , mechanical engineering , computer network , asynchronous communication , computer science , engineering
Summary Background To determine the prevalence of main inspiratory asynchrony events during non‐invasive intermittent positive‐pressure ventilation (NIV) for severe bronchiolitis. Ventilator response time and asynchrony were compared in neurally adjusted ventilator assist (NAVA) and in pressure assist/control (PAC) modes. Methods This prospective physiological study was performed in a university hospital's paediatric intensive care unit and included 11 children (aged 35.2 ± 23 days) with respiratory syncytial virus bronchiolitis with failure of nCPAP. Patients received NIV for 2 hr in PAC mode followed by 2 hr in NAVA mode. Electrical activity of the diaphragm and pressure curves were recorded for 10 min. Trigger delay, main asynchronies (auto‐triggering, double triggering, or non‐triggered breaths) were analyzed, and the asynchrony index was calculated for each period. Results The asynchrony index was lower during NAVA than during PAC (3 ± 3% vs. 38 ± 21%, P < 0.0001), and the trigger delay was shorter (43.9 ± 7.2 vs. 116.0 ± 38.9 ms, P < 0.0001). Ineffective efforts were significantly less frequent in NAVA mode (0.54 ± 1.5 vs. 21.8 ± 16.5 events/min, P = 0.01). Patient respiratory rates were similar, but the ventilator rate was higher in NAVA than in PAC mode (59.5 ± 17.9 vs. 49.8 ± 8.5/min, P = 0.03). The TcPCO 2 baselines values (64 ± 12 mmHg vs. 62 ± 9 mmHg during NAVA, P = 0.30) were the same and their evolution over the 2 hr study period (−6 ± 10 mmHg vs. −12 ± 17 mmHg during NAVA, P = 0.36) did not differ. Conclusion Patient‐ventilator inspiratory asynchronies and trigger delay were dramatically lower in NAVA mode than in PAC mode during NIV in infants with severe bronchiolitis. Pediatr Pulmonol. 2015; 50:1320–1327. © 2014 Wiley Periodicals, Inc.