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Neurally adjusted ventilator assist

Federico Longhini, Ling Liu, Chun Pan, Jianfeng Xie, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Yi Yang, Paolo Navalesi, Haibo Qiu
BACKGROUND: In patients with COPD exacerbation, noninvasive ventilation (NIV) is strongly recommended. NIV is generally delivered by using pneumatically triggered and cycled pressure support through a face mask. A specific method to generate neurally-controlled pressure support has been shown to improve comfort and patient-ventilator interaction. In addition, the helmet interface was better tolerated by patients compared with a face mask. Herein, we compared neurally-controlled pressure support through a helmet with pressure support through a face mask with respect to subject comfort, breathing pattern, gas exchange, pressurization and triggering performance, and patient-ventilator synchrony...
February 12, 2019: Respiratory Care
Olivier Lamouret, Laure Crognier, Fanny Vardon Bounes, Jean-Marie Conil, Caroline Dilasser, Thibaut Raimondi, Stephanie Ruiz, Antoine Rouget, Clément Delmas, Thierry Seguin, Vincent Minville, Bernard Georges
BACKGROUND: Prolonged weaning is a major issue in intensive care patients and tracheostomy is one of the last resort options. Optimized patient-ventilator interaction is essential to weaning. The purpose of this study was to compare patient-ventilator synchrony between pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA) in a selected population of tracheostomised patients. METHODS: We performed a prospective, sequential, non-randomized and single-centre study...
January 7, 2019: Critical Care: the Official Journal of the Critical Care Forum
X T Xu, Q Sun, J F Xie, C Pan, Y Yang, H B Qiu, L Liu
Objective: To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation. Methods: AECOPD patients with intrinsic PEEP (PEEPi) greater than or equal to 3 cmH(2)O (1 cmH(2)O=0.098 kPa) were enrolled during invasive mechanical ventilation. Subjects were ventilated with low, medium and high pressure under either NAVA or PSV mode...
January 1, 2019: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Nathanya Baez Hernandez, Abdulhamid Milad, Yi Li, Andrew H Van Bergen
We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. The ventilatory and gas exchange parameters for the 24 h pre- and post-transition to NAVA were compared...
January 2, 2019: Pediatric Cardiology
Jun Kataoka, Akira Kuriyama, Yasuhiro Norisue, Shigeki Fujitani
BACKGROUND: Proportional modes (proportional assist ventilation, PAV, and neurally adjusted ventilatory assist, NAVA) could improve patient-ventilator interaction and consequently may be efficient as a weaning mode. The purpose of this systematic review is to examine whether proportional modes improved patient-ventilator interaction and whether they had an impact on the weaning success and length of mechanical ventilation, in comparison with PSV. METHODS: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through May 13, 2018...
December 10, 2018: Annals of Intensive Care
Shawn Hughes
The art and science of neonatal ventilation continue to evolve with advances in technology and as a result of evidenced based research. Although some historically administered therapies remain such as nasal continuous positive airway pressure, newer therapies have emerged in the neonatal intensive care unit such as pressure regulated volume control and neurally adjusted ventilatory assist. The challenge for clinicians continues to be which mode will support the patient's medical diagnosis with minimal barotrauma or lung injury...
December 2018: Critical Care Nursing Clinics of North America
Diana Jansen, Annemijn H Jonkman, Lisanne Roesthuis, Suvarna Gadgil, Johannes G van der Hoeven, Gert-Jan J Scheffer, Armand Girbes, Jonne Doorduin, Christer S Sinderby, Leo M A Heunks
BACKGROUND: Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure...
September 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Michelle L Jones, Shasha Bai, Tracy L Thurman, Shirley J Holt, Mark J Heulitt, Sherry E Courtney
BACKGROUND: Noninvasive ventilation (NIV) is commonly used in neonates. A mode of NIV called neurally adjusted ventilatory assist (NAVA) offers patient-ventilator interactions by using electrical activity of the diaphragm to control mechanical breaths. We hypothesized that the work of breathing (WOB) would decrease with NIV-NAVA. Secondary objectives evaluated the impact of NIV-NAVA on arterial blood gases and respiratory parameters. METHODS: We compared WOB between synchronized breaths in NIV-NAVA and NIV in piglets with healthy lungs and then with surfactant-depleted lungs...
December 2018: Respiratory Care
M Walesa, S Bayat, G Albu, A Baudat, F Petak, W Habre
BACKGROUND: Various ventilation strategies have been proposed to reduce ventilation-induced lung injury that occurs even in individuals with healthy lungs. We compared new modalities based on an individualised physiological variable ventilation model to a conventional pressure-controlled mode. METHODS: Rabbits were anaesthetised and ventilated for up to 7 h using pressure-controlled ventilation with (Group PCS, n=10), and without (Group PC, n=10) regular sighs...
October 2018: British Journal of Anaesthesia
Francesca Campoccia Jalde, Fredrik Jalde, Mats K E B Wallin, Fernando Suarez-Sipmann, Peter J Radell, David Nelson, Staffan Eksborg, Peter V Sackey
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Currently, there is no standardized method to set the support level in neurally adjusted ventilatory assist (NAVA). The primary aim was to explore the feasibility of titrating NAVA to specific diaphragm unloading targets, based on the neuroventilatory efficiency (NVE) index. The secondary outcome was to investigate the effect of reduced diaphragm unloading on distribution of lung ventilation. METHODS: This is a randomized crossover study between pressure support and NAVA at different diaphragm unloading at a single neurointensive care unit...
October 2018: Anesthesiology
Eline Oppersma, Jonne Doorduin, Petra J Gooskens, Lisanne H Roesthuis, Erik H F M van der Heijden, Johannes G van der Hoeven, Peter H Veltink, Leo M A Heunks
BACKGROUND: Non-invasive ventilation (NIV) provides ventilatory support for patients with respiratory failure. However, the glottis can act as a closing valve, limiting effectiveness of NIV. This study investigates the patency of the glottis during NIV in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). METHODS: Electrical activity of the diaphragm, flow, pressure and videolaryngoscopy were acquired. NIV was randomly applied in pressure support (PSV) and neurally adjusted ventilatory assist (NAVA) mode with two levels of support...
January 2019: Respiratory Physiology & Neurobiology
Marcelo Alcantara Holanda, Renata Dos Santos Vasconcelos, Juliana Carvalho Ferreira, Bruno Valle Pinheiro
Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow...
July 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
Yu Inata, Muneyuki Takeuchi
Neurally adjusted ventilatory assist (NAVA), by capturing the electrical activity of the diaphragm, improves patient-ventilator synchrony. It is, however, not completely immune from auto-triggering by cardiac electrical activity as illustrated in this case. Stringent observation of respiratory rate and vigilance for this phenomenon is warranted when using NAVA.
July 2018: Clinical Case Reports
Arata Oda, Yoshiya Kamei, Takehiko Hiroma, Tomohiko Nakamura
BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is expected to improve respiratory outcomes in preterm infants, but it has not yet been evaluated. We investigated whether NAVA could improve respiratory outcomes and reduce sedation use in extremely low-birthweight infants (ELBWI). METHODS: A retrospective cohort study was conducted based on patient charts at the Nagano Children's Hospital neonatal intensive care unit, Japan. Infants who were born at <27 weeks' gestation were included...
September 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
Fermín García-Muñoz Rodrigo, Lourdes Urquía Martí, Gloria Galán Henríquez, Sonia Rivero Rodríguez, Alberto Hernández Gómez
OBJECTIVE: To characterize the neural breathing pattern in preterm infants supported with non-invasive neurally adjusted ventilatory assist (NIV-NAVA). STUDY DESIGN: Single-center prospective observational study. The electrical activity of the diaphragm (EAdi) was periodically recorded in 30-second series with the Edi catheter and the Servo-n software (Maquet, Solna, Sweden) in preterm infants supported with NIV-NAVA. The EAdiPeak , EAdiMin , EAdiTonic , EAdiPhasic , neural inspiratory, and expiratory times (nTi and nTe) and the neural respiratory rate (nRR) were calculated...
June 18, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Vijay Hadda, Tajamul Hussain Shah, Karan Madan, Anant Mohan, Gopi C Khilnani, Randeep Guleria
Patient-ventilator asynchrony is common with noninvasive ventilation (NIV) used for management of acute exacerbation of chronic obstructive pulmonary disease (COPD). Neurally adjusted ventilator assist (NAVA) is a mode of ventilatory support which can minimize the patient-ventilator asynchrony. Delivering NIV with NAVA (NIV-NAVA) during acute exacerbation of COPD seems a logical approach and may be useful in reducing patient-ventilator asynchrony. However, there are no published reports which describe the use of NIV-NAVA for management of acute exacerbation of COPD...
January 2018: Lung India: Official Organ of Indian Chest Society
Arata Oda, Liisa Lehtonen, Hanna Soukka
No abstract text is available yet for this article.
April 2018: Acta Paediatrica
Benjamin Crulli, Mariam Khebir, Baruch Toledano, Suzanne Vobecky, Nancy Poirier, Guillaume Emeriaud
BACKGROUND: After pediatric cardiac surgery, ventilation with high airway pressures can be detrimental to right ventricular function and pulmonary blood flow. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interactions, helping maintain spontaneous ventilation. This study reports our experience with the use of NAVA in children after a cardiac surgery. We hypothesize that using NAVA in this population is feasible and allows for lower ventilation pressures. METHODS: We retrospectively studied all children ventilated with NAVA (invasively or noninvasively) after undergoing cardiac surgery between January 2013 and May 2015 in our pediatric intensive care unit...
February 2018: Respiratory Care
Pradeep V Mally, Jennifer Beck, Christer Sinderby, Martha Caprio, Sean M Bailey
OBJECTIVE: To compare neurally adjusted ventilatory assist and conventional ventilation on patient-ventilator interaction and neural breathing patterns, with a focus on central apnea in preterm infants. DESIGN: Prospective, observational cross-over study of intubated and ventilated newborns. Data were collected while infants were successively ventilated with three different ventilator conditions (30 min each period): 1) synchronized intermittent mandatory ventilation (SIMV) combined with pressure support at the clinically prescribed, SIMV with baseline settings (SIMVBL), 2) neurally adjusted ventilatory assist, 3) same as SIMVBL, but with an adjustment of the inspiratory time of the mandatory breaths (SIMV with adjusted settings [SIMVADJ]) using feedback from the electrical activity of the diaphragm)...
January 2018: Pediatric Critical Care Medicine
Juliana C Ferreira, Fabia Diniz-Silva, Henrique T Moriya, Adriano M Alencar, Marcelo B P Amato, Carlos R R Carvalho
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs...
November 7, 2017: BMC Pulmonary Medicine
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