B LoVerde1, K S Firestone2, H M Stein3. 1. Department of Neonatology, University of Maryland, Baltimore, MD, USA. 2. Department of Neonatology, Children's Hospital of Akron, Akron, OH, USA. 3. Department of Neonatology, Promedica Toledo Children's Hospital, Toledo, OH, USA.
Abstract
OBJECTIVE: Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers ventilatory support in synchrony to the patient's respiratory needs using NAVA level, a proportionality constant that converts the electrical activity of the diaphragm (Edi) into a peak pressure (PIP). Recent published studies suggest that neonates can control the delivered ventilatory support through neural feedback. Systematically increasing the NAVA level initially increases the PIP while maintaining a constant Edi until an inflection point or breakpoint (BrP) is reached, at which time the PIP plateaus and the Edi signal decreases. This study was performed to establish if there is a correlation of pre- and post-extubation BrP in premature neonates. STUDY DESIGN: NAVA level was increased by 0.5 cm H2O mcV-1 every 3 min from 0.1 to 3.0 cm H2O mcV-1. PIP and Edi Peak and Minimum were recorded. STATISTICS: PIP and phasic Edi (Edi peak-Edi min) were averaged for each NAVA level, plotted on a graph, and the BrP was determined by visual inspection of the inflection point for PIP. The data from the studies were then combined by averaging each variable at the BrP and for each change in NAVA level above and below the BrP. RESULTS: Fifteen infants were studied for paired titration studies. PIP increased until the BrP was reached and then plateaued during both the intubated and extubated titration studies. Edi decreased after the BrP was reached during the titration studies. The BrP increased when patients were extubated from NAVA to noninvasive (NIV) NAVA. As the NAVA level rose above the BrP, PIP plateaued at a higher level and Edi decreased less during the NIV NAVA titration study. CONCLUSIONS: Neonates demonstrated an increase in BrP, higher PIP and Edi when extubated from NAVA to NIV NAVA. This is most likely owing to the inefficiencies of NIV ventilation and suggests that neonates require a higher NAVA level when transitioning from NAVA to NIV NAVA.
OBJECTIVE: Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers ventilatory support in synchrony to the patient's respiratory needs using NAVA level, a proportionality constant that converts the electrical activity of the diaphragm (Edi) into a peak pressure (PIP). Recent published studies suggest that neonates can control the delivered ventilatory support through neural feedback. Systematically increasing the NAVA level initially increases the PIP while maintaining a constant Edi until an inflection point or breakpoint (BrP) is reached, at which time the PIP plateaus and the Edi signal decreases. This study was performed to establish if there is a correlation of pre- and post-extubation BrP in premature neonates. STUDY DESIGN: NAVA level was increased by 0.5 cm H2O mcV-1 every 3 min from 0.1 to 3.0 cm H2O mcV-1. PIP and Edi Peak and Minimum were recorded. STATISTICS: PIP and phasic Edi (Edi peak-Edi min) were averaged for each NAVA level, plotted on a graph, and the BrP was determined by visual inspection of the inflection point for PIP. The data from the studies were then combined by averaging each variable at the BrP and for each change in NAVA level above and below the BrP. RESULTS: Fifteen infants were studied for paired titration studies. PIP increased until the BrP was reached and then plateaued during both the intubated and extubated titration studies. Edi decreased after the BrP was reached during the titration studies. The BrP increased when patients were extubated from NAVA to noninvasive (NIV) NAVA. As the NAVA level rose above the BrP, PIP plateaued at a higher level and Edi decreased less during the NIV NAVA titration study. CONCLUSIONS: Neonates demonstrated an increase in BrP, higher PIP and Edi when extubated from NAVA to NIV NAVA. This is most likely owing to the inefficiencies of NIV ventilation and suggests that neonates require a higher NAVA level when transitioning from NAVA to NIV NAVA.
Authors: Christer Sinderby; Jennifer Beck; Jadranka Spahija; Michel de Marchie; Jacques Lacroix; Paolo Navalesi; Arthur S Slutsky Journal: Chest Date: 2007-03 Impact factor: 9.410
Authors: J P Viale; S Duperret; P Mahul; B Delafosse; C Delpuech; D Weismann; G Annat Journal: Am J Respir Crit Care Med Date: 1998-02 Impact factor: 21.405
Authors: Dimitrios Ververidis; Mark Van Gils; Christina Passath; Jukka Takala; Lukas Brander Journal: IEEE Trans Biomed Eng Date: 2011-06-16 Impact factor: 4.538
Authors: Lukas Brander; Christer Sinderby; François Lecomte; Howard Leong-Poi; David Bell; Jennifer Beck; James N Tsoporis; Rosanna Vaschetto; Marcus J Schultz; Thomas G Parker; Jesús Villar; Haibo Zhang; Arthur S Slutsky Journal: Intensive Care Med Date: 2009-11 Impact factor: 17.440
Authors: Lukas Brander; Howard Leong-Poi; Jennifer Beck; Fabrice Brunet; Stuart J Hutchison; Arthur S Slutsky; Christer Sinderby Journal: Chest Date: 2008-11-18 Impact factor: 9.410
Authors: Stephanie A Bailes; Kimberly S Firestone; Diane K Dunn; Neil L McNinch; Miraides F Brown; Teresa A Volsko Journal: Respir Care Date: 2015-11-03 Impact factor: 2.258