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Cardiorespiratory effects of NIV‐NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: A randomized crossover trial
Author(s) -
Latremouille Samantha,
Bhuller Monica,
Shalish Wissam,
Sant'Anna Guilherme
Publication year - 2021
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.25607
Subject(s) - medicine , cardiorespiratory fitness , anesthesia , crossover study , continuous positive airway pressure , ventilation (architecture) , respiratory system , gestational age , diaphragmatic breathing , heart rate , respiratory rate , diaphragm (acoustics) , cardiology , blood pressure , obstructive sleep apnea , pregnancy , mechanical engineering , physics , alternative medicine , engineering , pathology , biology , loudspeaker , acoustics , genetics , placebo
Objective Investigate the cardiorespiratory effects of noninvasive neurally adjusted ventilatory assist (NIV‐NAVA), nonsynchronized nasal intermittent positive pressure ventilation (NIPPV), and nasal continuous positive airway pressure (NCPAP) shortly after extubation. Hypothesis Types of noninvasive pressure support and the presence of synchronization may affect cardiorespiratory parameters. Study Design Randomized crossover trial. Patient–Subject Selection Infants with birth weight (BW) 1250 g or under, undergoing their first planned extubation were randomly assigned to all three modes using a computer‐generated sequence. Methodology Electrocardiogram and electrical activity of the diaphragm (Edi) were recorded for 30 min on each mode. Analysis of heart rate variability (HRV), diaphragmatic activity (Edi area, breath area, amplitude, inspiratory and expiratory times), and respiratory variability were compared between modes. Results Twenty‐three infants had full data recordings and analysis: Median (IQR) gestational age = 25.9 weeks (25.2–26.4), BW = 760 g (595–900), and postnatal age 7 (4–19) days. There were no differences in HRV between modes. A significantly reduced Edi area and breath amplitude, and increased coefficient of variation (CV) of breath amplitude were observed during NIV‐NAVA and NIPPV compared to NCPAP. A higher proportion of assisted breaths (99% vs. 51%; p < .001) provided a higher mean airway pressure (MAP; 9.4 vs. 8.2 cmH 2 O; p = .002) with lower peak inflation pressures (PIPs; 14 vs. 16 cmH 2 O; p < .001) during NIV‐NAVA compared to NIPPV. Conclusions NIV‐NAVA and NIPPV applied shortly after extubation were associated with lower respiratory efforts and higher respiratory variability. These effects were more evident for NIV‐NAVA where optimal patient–ventilator synchronization provided a higher MAP with lower PIPs.