Electronic ArticleNeurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: Nested study☆,☆☆
Section snippets
Background
Mechanical ventilation has significantly evolved in recent years; and a general trend towards a more gentle ventilatory approach is widely accepted to reduce negative consequences, such as ventilation-associated pneumonia and ventilator-induced lung injury [1]. Accordingly, new ventilatory techniques have been proposed, especially for patients with severe lung injury needing long ventilation [1], [2], [3].
One of the most recent novelties is the neurally adjusted ventilatory assist (NAVA), which
Study population
Eligible patients were all infants younger than 1 year affected by ARDS according to the American/European Consensus criteria [20] and needing to be ventilated by “rescue” high-frequency oscillatory ventilation (HFOV). The criteria to start HFOV are defined below. Since NAVA was introduced in our pediatric intensive care unit (PICU) in January 2010, from this date onwards, NAVA was used to wean patients after the critical phase under HFOV.
For each study patient, 2 control infants were chosen
Results
All eligible infants with severe ARDS hospitalized during 2010 and treated with HFOV were enrolled. Table 1 reports baseline details of patients and the nested control group: the 2 groups were well matched for basic confounding variables and had similar clinical severity in terms of PRISM-III24. All babies were successfully extubated, and no reintubation was performed in both groups. Two babies per each group died several months after the extubation (2 for sepsis, 1 for bronchopulmonary
Discussion
This is the first preliminary study with a parallel design about NAVA in infants affected by severe ARDS. Physiologic and ventilatory findings suggest that NAVA is safe and noninferior to PSV in the weaning phase of severe pediatric ARDS.
Our data are consistent with previous results coming from an animal model of pediatric acute lung injury: similar reduction of peak pressure and improved synchrony were described [10]. In NAVA, we also found a tendency toward a RR higher than in PSV; and
Conclusions
Neurally adjusted ventilatory assist seems well tolerated and feasible in infants recovering from severe ARDS previously requiring HFOV. It may be valuable in the weaning phase of severe pediatric ARDS, and the present data are useful to build adequately powered randomized clinical trials.
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Cited by (52)
Nasal High-Frequency Ventilation
2021, Clinics in PerinatologyCitation Excerpt :Owing to its capability to washout CO2, NHFOV is used as first intention in extremely preterm infants experiencing hypercapnic respiratory failure. Conventional noninvasive respiratory support is initially used in infants with hypoxemic respiratory failure and NHFOV is regarded as rescue intervention in case of failure; conventional noninvasive ventilation is synchronized, either using neurally adjusted ventilator assist93 or flow/pressure-sensors to increase its efficacy and optimize patient-ventilator interaction (more details in the figure legend). Point-of-care echocardiography is also performed according to international guidelines94: when there are signs of pulmonary hypertension and this significantly influences hypoxia, nebulized iloprost is started,95 using modern vibrating-mesh nebulizers inserted on the inspiratory limb.96
Neurally Adjusted Ventilatory Assist in Newborns
2021, Clinics in PerinatologyCitation Excerpt :The remainder of the studies demonstrated equivalence.33 Three studies in infants reported results about comfort, two of which showed improved comfort with NAVA77,94 in the pediatric population. Nam and colleagues30 reported increased comfort with increasing NAVA levels in preterms.
Contemporary ventilatory strategies for surgical patients
2019, Seminars in Pediatric SurgeryCitation Excerpt :In children, most studies show feasibility, but they cannot establish clinical significance due to the small sample size studied. The majority of the pediatric literature describes pilot studies, which compare NAVA to traditional, lung-protective CMV in up to 10 patients.34–36 Neonatal data is also limited.
S2k-Guideline Published by the german respiratory society
2019, Pneumologie
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Authors’ contribution: MP ideated the study, analyzed data, and wrote the first draft of the paper. DLD analyzed data, gave important contribution to study design, and wrote the article draft. RC collected data, performed the neurally adjusted ventilatory assist tracing analysis, and gave important intellectual contribution to the paper. DB, FV, LM, AP, and RDS collected data and helped in their analysis and interpretation. They also gave important intellectual contribution to the paper. GC helped to design the study, supervised the whole research, and gave important intellectual contribution both to the data acquisition and interpretation and to the paper preparation. All coauthors approved the paper in the final version.
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Competing interests: The authors have no conflict of interests, financial relationship, or funding to declare.