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01.12.2011 | Original

Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation

verfasst von: Gianmaria Cammarota, Carlo Olivieri, Roberta Costa, Rosanna Vaschetto, Davide Colombo, Emilia Turucz, Federico Longhini, Francesco Della Corte, Giorgio Conti, Paolo Navalesi

Erschienen in: Intensive Care Medicine | Ausgabe 12/2011

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Abstract

Purpose

Neurally adjusted ventilatory assist (NAVA) has been shown to improve patient–ventilator interaction and reduce asynchronies in intubated patients, as opposed to pressure support ventilation (PSV). This is a short-term head-to-head physiologic comparison between PSV and NAVA in delivering noninvasive ventilation through a helmet (h-NIV), in patients with postextubation hypoxemic acute respiratory failure.

Methods

Ten patients underwent three 20-min trials of h-NIV in PSV, NAVA, and PSV again. Arterial blood gases (ABGs) were assessed at the end of each trial. Diaphragm electrical activity (EAdi) and airway pressure (P _aw) were recorded to derive neural and mechanical respiratory rate and timing, inspiratory (delay_TR-insp) and expiratory trigger delays (delay_TR-exp), time of synchrony between diaphragm contraction and ventilator assistance (time_synch), and the asynchrony index (AI).

Results

ABGs, peak EAdi, peak P _aw, respiratory rate, either neural or mechanical, neural timing, and delay_TR-exp were not different between trials. Compared with PSV, with NAVA the mechanical expiratory time was significantly shorter, while the inspiratory time and duty cycle were greater. Time_synch was 0.79 ± 0.35 s in NAVA versus 0.60 ± 0.30 s and 0.55 ± 0.29 s during the PSV trials (p < 0.01 for both). AI exceeded 10% during both PSV trials, while not in NAVA (p < 0.001).

Conclusions

Compared with PSV, NAVA improves patient–ventilator interaction and synchrony, with no difference in gas exchange, respiratory rate, and neural drive and timing.

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Titel: Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation
verfasst von: Gianmaria Cammarota
Carlo Olivieri
Roberta Costa
Rosanna Vaschetto
Davide Colombo
Emilia Turucz
Federico Longhini
Francesco Della Corte
Giorgio Conti
Paolo Navalesi
Publikationsdatum: 01.12.2011
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 12/2011
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2382-2

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Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation