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Lee J, Parikka V, Lehtonen L, Soukka H. Backup ventilation during neurally adjusted ventilatory assist in preterm infants. Pediatr Pulmonol 2021; 56:3342-3348. [PMID: 34310871 DOI: 10.1002/ppul.25583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To analyze the proportion of backup ventilation during neurally adjusted ventilatory assist (NAVA) in preterm infants at different postmenstrual ages (PMAs) and to analyze the trends in backup ventilation in relation to clinical deteriorations. METHODS A prospective observational study was conducted in 18 preterm infants born at a median (range) 27+4 (23+4 -34+4 ) weeks of gestation with a median (range) birth weight of 1,100 (460-2,820) g, who received respiratory support with either invasive or noninvasive NAVA. Data on ventilator settings and respiratory variables were collected daily; the mean values of each 24-h recording were computed for each respiratory variable. For clinical deterioration, ventilator data were reviewed at 6-h intervals for 30 h before the event. RESULTS A total of 354 patient days were included: 269 and 85 days during invasive and noninvasive NAVA, respectively. The time on backup ventilation (%/min) significantly decreased with increasing PMA during both invasive and noninvasive NAVA. The neural respiratory rate did not change over time. The median time on backup ventilation was less than 15%/min, and the median neural respiratory rate was more than 45 breaths/min for infants above 26+0 weeks PMA during invasive NAVA. The relative backup ventilation significantly increased before the episode of clinical deterioration. CONCLUSION The proportion of backup ventilation during NAVA showed how the control of breathing matured with increasing PMA. Even the most immature infants triggered most of their breaths by their own respiratory effort. An acute increase in the proportion of backup ventilation anticipated clinical deterioration.
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Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Incheon, South Korea
- Department of Pediatrics, Inha University College of Medicine, Incheon, South Korea
| | - Vilhelmiina Parikka
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Turku, Turku, Finland
| | - Hanna Soukka
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Turku, Turku, Finland
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Villar J, Belda J, Blanco J, Suarez-Sipmann F, Añón JM, Pérez-Méndez L, Ferrando C, Parrilla D, Montiel R, Corpas R, González-Higueras E, Pestaña D, Martínez D, Fernández L, Soro M, García-Bello MA, Fernández RL, Kacmarek RM. Neurally adjusted ventilatory assist in patients with acute respiratory failure: study protocol for a randomized controlled trial. Trials 2016; 17:500. [PMID: 27737690 PMCID: PMC5064782 DOI: 10.1186/s13063-016-1625-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/25/2016] [Indexed: 12/25/2022] Open
Abstract
Background Patient-ventilator asynchrony is a common problem in mechanically ventilated patients with acute respiratory failure. It is assumed that asynchronies worsen lung function and prolong the duration of mechanical ventilation (MV). Neurally Adjusted Ventilatory Assist (NAVA) is a novel approach to MV based on neural respiratory center output that is able to trigger, cycle, and regulate the ventilatory cycle. We hypothesized that the use of NAVA compared to conventional lung-protective MV will result in a reduction of the duration of MV. It is further hypothesized that NAVA compared to conventional lung-protective MV will result in a decrease in the length of ICU and hospital stay, and mortality. Methods/design This is a prospective, multicenter, randomized controlled trial in 306 mechanically ventilated patients with acute respiratory failure from several etiologies. Only patients ventilated for less than 5 days, and who are expected to require prolonged MV for an additional 72 h or more and are able to breathe spontaneously, will be considered for enrollment. Eligible patients will be randomly allocated to two ventilatory arms: (1) conventional lung-protective MV (n = 153) and conventional lung-protective MV with NAVA (n = 153). Primary outcome is the number of ventilator-free days, defined as days alive and free from MV at day 28 after endotracheal intubation. Secondary outcomes are total length of MV, and ICU and hospital mortality. Discussion This is the first randomized clinical trial examining, on a multicenter scale, the beneficial effects of NAVA in reducing the dependency on MV of patients with acute respiratory failure. Trial registration ClinicalTrials.gov website (NCT01730794). Registered on 15 November 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1625-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellon 11, 28029, Madrid, Spain. .,Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, 4th Floor-South Wing, 35019, Las Palmas de Gran Canaria, Spain. .,Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Javier Belda
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Jesús Blanco
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellon 11, 28029, Madrid, Spain.,Intensive Care Unit, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Fernando Suarez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellon 11, 28029, Madrid, Spain.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital, Akademiska Sjukhuset, Ing 40, Tr 3, SE-75185, Uppsala, Sweden
| | - José Manuel Añón
- Intensive Care Unit, Hospital Virgen de La Luz, Hermandad de Donantes de Sangre s/n, 16002, Cuenca, Spain
| | - Lina Pérez-Méndez
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellon 11, 28029, Madrid, Spain.,Division of Clinical Epidemiology and Biostatistics, Research Unit, Hospital Universitario NS de Candelaria, Carretera General del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Carlos Ferrando
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Dácil Parrilla
- Intensive Care Unit, Hospital Universitario NS de Candelaria, Carretera General del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Raquel Montiel
- Intensive Care Unit, Hospital Universitario NS de Candelaria, Carretera General del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Ruth Corpas
- Intensive Care Unit, Hospital General NS del Prado, Carretera de Madrid, Km. 114, 45600, Talavera de la Reina, Toledo, Spain
| | - Elena González-Higueras
- Intensive Care Unit, Hospital Virgen de La Luz, Hermandad de Donantes de Sangre s/n, 16002, Cuenca, Spain
| | - David Pestaña
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain
| | - Domingo Martínez
- Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Carretera Madrid-Cartagena s/n, 30120, El Palmar, Murcia, Spain
| | - Lorena Fernández
- Intensive Care Unit, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Marina Soro
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Miguel Angel García-Bello
- Division of Biostatistics, Research Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, 35019, Las Palmas de Gran Canaria, Spain
| | - Rosa Lidia Fernández
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellon 11, 28029, Madrid, Spain.,Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, 4th Floor-South Wing, 35019, Las Palmas de Gran Canaria, Spain
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Anesthesiology, Harvard University, 55 Fruit Street Gray-Bigelow 444, Boston, MA, 02144, USA
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Singh PM, Borle A, Trikha A. Newer nonconventional modes of mechanical ventilation. J Emerg Trauma Shock 2014; 7:222-7. [PMID: 25114434 PMCID: PMC4126124 DOI: 10.4103/0974-2700.136869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 10/29/2013] [Indexed: 11/23/2022] Open
Abstract
The conventional modes of ventilation suffer many limitations. Although they are popularly used and are well-understood, often they fail to match the patient-based requirements. Over the years, many small modifications in ventilators have been incorporated to improve patient outcome. The ventilators of newer generation respond to patient's demands by additional feedback systems. In this review, we discuss the popular newer modes of ventilation that have been accepted in to clinical practice. Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety. The various modes discusses in this review are: Dual control modes (volume assured pressure support, volume support), Adaptive support ventilation, proportional assist ventilation, mandatory minute ventilation, Bi-level airway pressure release ventilation, (BiPAP), neurally adjusted ventilatory assist and NeoGanesh. Their working principles with their advantages and clinical limitations are discussed in brief.
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Affiliation(s)
- Preet Mohinder Singh
- Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India
| | - Anuradha Borle
- Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India
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