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Intubation rate, duration of noninvasive ventilation and mortality after noninvasive neurally adjusted ventilatory assist (NIV‐NAVA)
Author(s) -
Hansen Kristina K.,
Jensen Hanne I.,
Andersen Torben S.,
Christiansen Christian F.
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13499
Subject(s) - medicine , cohort , confounding , intubation , noninvasive ventilation , odds ratio , logistic regression , mechanical ventilation , anesthesia
Background Asynchrony is a common problem in patients treated with noninvasive ventilation (NIV). Neurally adjusted ventilatory assist (NAVA) has shown to improve patient‐ventilator interaction. However, it is unknown whether NIV‐NAVA improves outcomes compared to noninvasive pressure support (NIV‐PS). Methods This observational cohort study included patients 18 years or older receiving noninvasive ventilation using an oro‐nasal face mask for more than 2 hours in a Danish ICU. The study included a NIV‐NAVA cohort (year 2013‐2015) and two comparison cohorts: (a) a historical NIV‐PS cohort (year 2011‐2012) before the implementation of NIV‐NAVA at the ICU in 2013, and (b) a concurrent NIV‐PS cohort (year 2013‐2015). Outcomes of NIV‐NAVA (intubation rate, duration of NIV and 90‐day mortality) were assessed and compared using multivariable linear and logistic regression adjusted for relevant confounders. Results The study included 427 patients (91 in the NIV‐NAVA, 134 in the historic NIV‐PS and 202 in the concurrent NIV‐PS cohort). Patients treated with NIV‐NAVA did not have improved outcome after adjustment for measured confounders. Actually, there were statistically imprecise higher odds for intubation in NIV‐NAVA patients compared with both the historical [OR 1.48, CI (0.74‐2.97)] and the concurrent NIV‐PS cohort [OR 1.67, CI (0.87‐3.19)]. NIV‐NAVA might also have a longer length of NIV [63%, CI (19%‐125%)] and [139%, CI (80%‐213%)], and might have a higher 90‐day mortality [OR 1.24, CI (0.69‐2.25)] and [OR 1.39, CI (0.81‐2.39)]. Residual confounding cannot be excluded. Conclusion This present study found no improved clinical outcomes in patients treated with NIV‐NAVA compared to NIV‐PS.