Pierre-Marie Bertrand1, Emmanuel Futier2, Yannael Coisel3, Stefan Matecki4, Samir Jaber5, Jean-Michel Constantin1. 1. Department of Anesthesiology and Critical Care, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand. 2. Department of Anesthesiology and Critical Care, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand. Electronic address: efutier@chu-clermontferrand.fr. 3. Department of Anesthesiology and Critical Care (SAR B), Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France. 4. Institut National de la Santé et de la Recherche Médicale (INSERM), Unit U1046, University of Montpellier, Montpellier, France. 5. Department of Anesthesiology and Critical Care (SAR B), Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Unit U1046, University of Montpellier, Montpellier, France.
Abstract
BACKGROUND: Patient-ventilator asynchrony is common during noninvasive ventilation (NIV) with pressure support ventilation (PSV). We examined the effect of neurally adjusted ventilatory assist (NAVA) delivered through a facemask on synchronization in patients with acute respiratory failure (ARF). METHODS: This was a prospective, physiologic, crossover study of 13 patients with ARF (median Pa(O(2))/F(IO(2)), 196 [interquartile range (IQR), 142-225]) given two 30-min trials of NIV with PSV and NAVA in random order. Diaphragm electrical activity (EAdi), neural inspiratory time (T(In)), trigger delay (Td), asynchrony index (AI), arterial blood gas levels, and patient discomfort were recorded. RESULTS: There were significantly fewer asynchrony events during NAVA than during PSV (10 [IQR, 5-14] events vs 17 [IQR, 8-24] events, P = .017), and the occurrence of severe asynchrony (AI > 10%) was also less under NAVA (P = .027). Ineffective efforts and delayed cycling were significantly less with NAVA (P < .05 for both). NAVA was also associated with reduced Td (0 [IQR, 0-30] milliseconds vs 90 [IQR, 30-130] milliseconds, P < .001) and inspiratory time in excess (10 [IQR, 0-28] milliseconds vs 125 [IQR, 20-312] milliseconds, P < .001), but T(In) was similar under PSV and NAVA. The EAdi signal to its maximal value was higher during NAVA than during PSV ( P = .017). There were no significant differences in arterial blood gases or patient discomfort under PSV and NAVA. CONCLUSION: In view of specific experimental conditions, our comparison of PSV and NAVA indicated that NAVA significantly reduced severe patient-ventilator asynchrony and resulted in similar improvements in gas exchange during NIV for ARF. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01426178; URL: www.clinicaltrials.gov.
RCT Entities:
BACKGROUND:Patient-ventilator asynchrony is common during noninvasive ventilation (NIV) with pressure support ventilation (PSV). We examined the effect of neurally adjusted ventilatory assist (NAVA) delivered through a facemask on synchronization in patients with acute respiratory failure (ARF). METHODS: This was a prospective, physiologic, crossover study of 13 patients with ARF (median Pa(O(2))/F(IO(2)), 196 [interquartile range (IQR), 142-225]) given two 30-min trials of NIV with PSV and NAVA in random order. Diaphragm electrical activity (EAdi), neural inspiratory time (T(In)), trigger delay (Td), asynchrony index (AI), arterial blood gas levels, and patient discomfort were recorded. RESULTS: There were significantly fewer asynchrony events during NAVA than during PSV (10 [IQR, 5-14] events vs 17 [IQR, 8-24] events, P = .017), and the occurrence of severe asynchrony (AI > 10%) was also less under NAVA (P = .027). Ineffective efforts and delayed cycling were significantly less with NAVA (P < .05 for both). NAVA was also associated with reduced Td (0 [IQR, 0-30] milliseconds vs 90 [IQR, 30-130] milliseconds, P < .001) and inspiratory time in excess (10 [IQR, 0-28] milliseconds vs 125 [IQR, 20-312] milliseconds, P < .001), but T(In) was similar under PSV and NAVA. The EAdi signal to its maximal value was higher during NAVA than during PSV ( P = .017). There were no significant differences in arterial blood gases or patient discomfort under PSV and NAVA. CONCLUSION: In view of specific experimental conditions, our comparison of PSV and NAVA indicated that NAVA significantly reduced severe patient-ventilator asynchrony and resulted in similar improvements in gas exchange during NIV for ARF. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01426178; URL: www.clinicaltrials.gov.
Authors: Eline Oppersma; Jonne Doorduin; Erik H F M van der Heijden; Johannes G van der Hoeven; Leo M A Heunks Journal: Crit Care Date: 2013-12-05 Impact factor: 9.097
Authors: Jonne Doorduin; Christer A Sinderby; Jennifer Beck; Johannes G van der Hoeven; Leo M A Heunks Journal: Crit Care Date: 2014-10-13 Impact factor: 9.097