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01-02-2012 | Original

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

Authors: Nicolò Patroniti, Giacomo Bellani, Erica Saccavino, Alberto Zanella, Giacomo Grasselli, Stefano Isgrò, Manuela Milan, Giuseppe Foti, Antonio Pesenti

Published in: Intensive Care Medicine | Issue 2/2012

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 (V _T) 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 V _T, no changes in respiratory rate (RR), and increases in V _T and EAdi variability. At high NAVA levels, an increase in V _T variability was associated with increased incidence of V _T 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 V _T, and increase in V _T 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 V _T above 8 or 10 ml/kg.

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Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindström L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433–1436PubMedCrossRef

Sinderby C, Beck J, Spahija J, de Marchie M, Lacroix J, Navalesi P, Slutsky AS (2007) Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healty subjects. Chest 131:711–717PubMedCrossRef

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 34:2010–2018PubMedCrossRef

Wu XY, Huang YZ, Yang Y, Liu SQ, Liu HG, Qiu HB (2009) Effects of neurally adjusted ventilatory assist on patient-ventilator synchrony in patients with acute respiratory distress syndrome. Zhonghua Jie He He Hu Xi Za Zhi 32:508–512PubMed

Brander L, Leong-Poi H, Beck J, Brunet F, Hutchison SJ, Slutsky AS, Sinderby C (2009) Titration and implementation of neurally adjusted ventilatory assist in critically ill patients. Chest 135:695–703PubMedCrossRef

Schmidt M, Demoule A, Cracco C, Gharbi A, Fiamma MN, Straus C, Duguet A, Gottfried SB, Similowski T (2010) Neurally adjusted ventilatory assist increases respiratory variability and complexity in acute respiratory failure. Anesthesiology 112:670–681PubMedCrossRef

Spahija J, de Marchie M, Albert M, Bellemare P, Delisle S, Beck J, Sinderby C (2010) Patient-ventilator interaction during pressure support ventilation and neutrally adjusted ventilatory assist. Crit Care Med 38:518–526PubMedCrossRef

Breatnach C, Conlon NP, Stack M, Healy M, O’Hare BP (2010) A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population. Pediatr Crit Care Med 11:7–11PubMedCrossRef

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 65:663–668PubMedCrossRef

10.

Brander L, Sinderby C, Lecomte F, Leong-Poi H, Bell D, Beck J, Tsoporis JN, Vaschetto R, Schultz MJ, Parker TG, Villar J, Zhang H, Slutsky AS (2009) Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury. Intensive Care Med 35:1979–1989PubMedCrossRef

11.

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 61:289–294PubMedCrossRef

12.

Allo JC, Beck J, Brander BrunetF, Slutsky AS, Sinderby CA (2006) Influence of neurally adjusted ventilatory assist (NAVA) and PEEP on breathing pattern in rabbits with acute lung injury. Crit Care Med 34:2997–3004PubMed

13.

Lecomte F, Brander L, Jalde F, Beck J, Qui H, Elie C, Slutsky AS, Brunet F, Sinderby C (2009) Physiological response to increasing levels of neurally adjusted ventilator assist (NAVA). Respir Physiol Neurobiol 30:117–124CrossRef

14.

Navalesi P, Costa R (2003) New modes of mechanical ventilation: proportional assist ventilation, neurally adjusted ventilatory assist and fractal ventilation. Curr Opin Crit Care 9:51–58PubMedCrossRef

15.

Barwing J, Ambold M, Linden N, Quintel M, Moerer O (2009) Evaluation of the catheter positioning for neurally adjusted ventilatory assist. Intensive Care Med 35:1809–1814PubMedCrossRef

16.

Ramsay MAE, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alpaxalone-alphadolone. Br Med J 2:656–659PubMedCrossRef

17.

Brochard L, Harf A, Lorino H, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139:513–521PubMedCrossRef

18.

Tokioka H, Saito S, Kosaka F (1989) Effects of pressure support ventilation on breathing pattern and respiratory work. Intensive Care Med 15:491–494PubMedCrossRef

19.

Jubran A, Van de Graaff WB, Tobin MJ (1995) Variability of patient-ventilator interaction with pressure support ventilation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152:129–136PubMed

20.

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 8:1477–1486CrossRef

21.

Rozé H, Lafrikh A, Perrier V, Germain A, Dewitte A, Gomez F, Janvier G, Ouattara A (2011) Daily titration of neurally adjusted ventilatory assist using the diaphragm electrical activity. Intensive Care Med 37:1087–1094PubMedCrossRef

22.

Tobin MJ, Mador MJ, Guenther SM, Lodato RF, Sackner MA (1988) Variability of resting respiratory center drive and timing in healthy subjects. J Appl Physiol 65:309–317PubMed

23.

Arold SP, Mora R, Lutchen KR, Ingenito EP, Suki B (2002) Variable tidal volume ventilation improves lung mechanics and gas exchange in a rodent model of acute lung injury. Am J Respir Crit Care Med 165:366–371PubMed

24.

Boker A, Haberman CJ, Girling L, Guzman RP, Louridas G, Tanner JR, Cheang M, Maycher BW, Bell DD, Doak GJ (2004) Variable ventilation improves perioperative lung function in patients undergoing abdominal aortic aneurysmectomy. Anesthesiology 100:608–616PubMedCrossRef

25.

Mutch WA, Harms S, Ruth GM, Kowalski SE, Girling LG, Lefevre GR (2000) Biologically variable or naturally noisy mechanical ventilation recruits atelectatic lung. Am J Respir Crit Care Med 162:319–323PubMed

26.

Patroniti N, Foti G, Cortinovis B, Maggioni E, Bigatello LM, Cereda M, Pesenti A (2002) Sigh improves gas exchange and lung volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation. Anesthesiology 96:788–794PubMedCrossRef

27.

Spieth PM, Carvalho AR, Pelosi P, Hoehn C, Meissner C, Kasper M, Hübler M, von Neindorff M, Dassow C, Barrenschee M, Uhlig S, Koch T, de Abreu MG (2009) Variable tidal volumes improve lung protective ventilation strategies in experimental lung injury. Am J Respir Crit Care Med 179:684–693PubMedCrossRef

28.

Allo JC, Beck JC, Brander L, Brunet F, Slutsky AS, Sinderby CA (2006) Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med 34:2997–3004PubMed

29.

Sammon MP, Bruce EN (1991) Vagal afferent activity increases dynamical dimension of respiration in rats. J Appl Physiol 70:1748–1762PubMed

Title: Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients
Authors: Nicolò Patroniti
Giacomo Bellani
Erica Saccavino
Alberto Zanella
Giacomo Grasselli
Stefano Isgrò
Manuela Milan
Giuseppe Foti
Antonio Pesenti
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2433-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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