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Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients

Nicolò Patroniti| Giacomo Bellani| Erica Saccavino| Alberto Zanella| Giacomo Grasselli| Stefano Isgrò| Manuela Milan| Giuseppe Foti| Antonio Pesenti
Original
Volume 38, Issue 2 / February , 2012

Pages 230 - 239

Abstract

Purpose

To investigate the effect of a wide range of assistance levels during neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) on respiratory pattern, breathing variability, and incidence of tidal volumes (VT) above 8 and 10 ml/kg in acute respiratory failure patients.

Methods

Eight increasing NAVA levels (0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 cmH2O/μV) and four increasing pressure support (PSV) levels (4, 8, 12, and 16 cmH2O) were applied to obtain 10 min of stable recordings in 15 patients.

Results

One out of 15 patients did not sustain the NAVA levels of 3, 4, and 5 cmH2O/μV and was excluded. The 5 cmH2O/μV NAVA level was not tolerated by three patients and it was excluded. Increasing NAVA levels were associated with decreased diaphragm electrical activity (EAdi), and, at variance with PSV, with small changes in VT, no changes in respiratory rate (RR), and increases in VT and EAdi variability. At high NAVA levels, an increase in VT variability was associated with increased incidence of VT above 8 and 10 ml/kg and an uncomfortable respiratory pattern in some patients.

Conclusions

Increasing NAVA levels were associated with no effect on RR, small increase in VT, and increase in VT and EAdi variability. Effective decrease in EAdi occurred at NAVA levels below 2–2.5 cmH2O/μV, while preserving respiratory variability and low risks of VT above 8 or 10 ml/kg.

Keywords

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