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Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Lise Piquilloud| Didier Tassaux| Emilie Bialais| Bernard Lambermont| Thierry Sottiaux| Jean Roeseler| Pierre-François Laterre| Philippe Jolliet| Jean-Pierre Revelly
Original
Volume 38, Issue 10 / October , 2012

Pages 1624 - 1631

Abstract

Purpose

To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient–ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask.

Methods

In this prospective interventional study we compared patient–ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (Td), the patient’s neural inspiratory time (Tin), ventilator pressurization duration (Tiv), inspiratory time in excess (Tiex), number of asynchrony events per minute and asynchrony index (AI) were determined.

Results

The study included 13 patients, six with COPD, and two with mixed pulmonary disease. Td was reduced with NAVA: median 35 ms (IQR 31–53 ms) versus 181 ms (122–208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median Tiex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5–3.1 events/min) versus 4.4 events/min (0.9–12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5–10.5 %) versus 15.8 % (5.5–49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO2 and PaCO2 were not different between ventilatory modes.

Conclusion

Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing Td and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

Keywords

References

  1. Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355
    • View reference on PubMed
    • View reference on publisher's website
  2. Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755
  3. Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A (2006) Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 173:164–170
    • View reference on PubMed
    • View reference on publisher's website
  4. Yamada Y, Du HL (2000) Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation: a mathematical approach. J Appl Physiol 88:2143–2150
    • View reference on PubMed
  5. Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522
  6. Vignaux L, Vargas F, Roeseler J, Tassaux D, Thille AW, Kossowsky MP, Brochard L, Jolliet P (2009) Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med 35:840–846
  7. Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880
    • View reference on PubMed
  8. Vignaux L, Tassaux D, Jolliet P (2007) Performance of noninvasive ventilation modes on ICU ventilators during pressure support: a bench model study. Intensive Care Med 33:1444–1451
  9. Vignaux L, Tassaux D, Carteaux G, Roeseler J, Piquilloud L, Brochard L, Jolliet P (2010) Performance of noninvasive ventilation algorithms on ICU ventilators during pressure support: a clinical study. Intensive Care Med 36:2053–2059
  10. Carteaux G, Lyazidi A, Cordoba-Izquierdo A, Vignaux L, Jolliet P, Thille AW, Richard JC, Brochard L (2012) Patient-ventilator asynchrony during noninvasive ventilation: a bench and clinical study. Chest. doi:10.1378/chest.11-2279
  11. Moerer O, Beck J, Brander L, Costa R, Quintel M, Slutsky AS, Brunet F, Sinderby C (2008) Subject-ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Med 34:1615–1623
  12. Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433–1436
    • View reference on PubMed
    • View reference on publisher's website
  13. Piquilloud L, Vignaux L, Bialais E, Roeseler J, Sottiaux T, Laterre PF, Jolliet P, Tassaux D (2011) Neurally adjusted ventilatory assist improves patient-ventilator interaction. Intensive Care Med 37:263–271
  14. Spahija J, de Marchie M, Albert M, Bellemare P, Delisle S, Beck J, Sinderby C (2010) Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 38:518–526
    • View reference on PubMed
    • View reference on publisher's website
  15. Colombo D, Cammarota G, Bergamaschi V, De Lucia M, Corte FD, Navalesi P (2008) Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 34:2010–2018
  16. Terzi N, Pelieu I, Guittet L, Ramakers M, Seguin A, Daubin C, Charbonneau P, du Cheyron D, Lofaso F (2010) Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: physiological evaluation. Crit Care Med 38:1830–1837
    • View reference on PubMed
    • View reference on publisher's website
  17. Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444
    • View reference on PubMed
    • View reference on publisher's website
  18. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822
    • View reference on PubMed
    • View reference on publisher's website
  19. Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, Sinderby C (2001) Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 164:419–424
    • View reference on PubMed
  20. Barwing J, Ambold M, Linden N, Quintel M, Moerer O (2009) Evaluation of the catheter positioning for neurally adjusted ventilatory assist. Intensive Care Med 35:1809–1814
  21. Beck J, Campoccia F, Allo JC, Brander L, Brunet F, Slutsky AS, Sinderby C (2007) Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits. Pediatr Res 61:289–294
    • View reference on PubMed
    • View reference on publisher's website
  22. Beck J, Reilly M, Grasselli G, Mirabella L, Slutsky AS, Dunn MS, Sinderby C (2009) Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants. Pediatr Res 65:663–668
    • View reference on PubMed
    • View reference on publisher's website
  23. Cammarota G, Olivieri C, Costa R, Vaschetto R, Colombo D, Turucz E, Longhini F, Della Corte F, Conti G, Navalesi P (2011) Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation. Intensive Care Med 37:1943–1950
  24. Thille AW, Cabello B, Galia F, Lyazidi A, Brochard L (2008) Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation. Intensive Care Med 34:1477–1486
  25. Tassaux D, Gainnier M, Battisti A, Jolliet P (2005) Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med 172:1283–1289
    • View reference on PubMed
    • View reference on publisher's website
  26. Prinianakis G, Delmastro M, Carlucci A, Ceriana P, Nava S (2004) Effect of varying the pressurisation rate during noninvasive pressure support ventilation. Eur Respir J 23:314–320
    • View reference on PubMed
    • View reference on publisher's website
  27. Viale JP, Duperret S, Mahul P, Delafosse B, Delpuech C, Weismann D, Annat G (1998) Time course evolution of ventilatory responses to inspiratory unloading in patients. Am J Respir Crit Care Med 157:428–434
    • View reference on PubMed
  28. Whitelaw WA, Derenne JP, Milic-Emili J (1975) Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol 23:181–199
    • View reference on PubMed
    • View reference on publisher's website
  29. Kondili E, Prinianakis G, Georgopoulos D (2003) Patient-ventilator interaction. Br J Anaesth 91:106–119
    • View reference on PubMed
    • View reference on publisher's website
  30. Nava S, Bruschi C, Fracchia C, Braschi A, Rubini F (1997) Patient-ventilator interaction and inspiratory effort during pressure support ventilation in patients with different pathologies. Eur Respir J 10:177–183
    • View reference on PubMed
    • View reference on publisher's website
  31. Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M (1997) Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 112:1592–1599
    • View reference on PubMed
    • View reference on publisher's website

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