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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2011

01-12-2011 | Original

Neurally adjusted ventilatory assist in patients with critical illness-associated polyneuromyopathy

Authors: Daniel Tuchscherer, Werner J. Z’Graggen, Christina Passath, Jukka Takala, Christer Sinderby, Lukas Brander

Published in: Intensive Care Medicine | Issue 12/2011

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Abstract

Purpose

Diaphragmatic electrical activity (EAdi), reflecting respiratory drive, and its feedback control might be impaired in critical illness-associated polyneuromyopathy (CIPM). We aimed to evaluate whether titration and prolonged application of neurally adjusted ventilatory assist (NAVA), which delivers pressure (P aw) in proportion to EAdi, is feasible in CIPM patients.

Methods

Peripheral and phrenic nerve electrophysiology studies were performed in 15 patients with clinically suspected CIPM and in 14 healthy volunteers. In patients, an adequate NAVA level (NAVAal) was titrated daily and was implemented for a maximum of 72 h. Changes in tidal volume (V t) generation per unit of EAdi (V t/EAdi) were assessed daily during standardized tests of neuro-ventilatory efficiency (NVET).

Results

In patients (median [range], 66 [44–80] years), peripheral electrophysiology studies confirmed CIPM. Phrenic nerve latency (PNL) was prolonged and diaphragm compound muscle action potential (CMAP) was reduced compared with healthy volunteers (p < 0.05 for both). NAVAal could be titrated in all but two patients. During implementation of NAVAal for 61 (37–64) h, the EAdi amplitude was 9.0 (4.4–15.2) μV, and the V t was 6.5 (3.7–14.3) ml/kg predicted body weight. V t, respiratory rate, EAdi, PaCO2, and hemodynamic parameters remained unchanged, while PaO2/FiO2 increased from 238 (121–337) to 282 (150–440) mmHg (p = 0.007) during NAVAal. V t/EAdi changed by −10 (−46; +31)% during the first NVET and by −0.1 (−26; +77)% during the last NVET (p = 0.048).

Conclusion

In most patients with CIPM, EAdi and its feedback control are sufficiently preserved to titrate and implement NAVA for up to 3 days. Whether monitoring neuro-ventilatory efficiency helps inform the weaning process warrants further evaluation.
Appendix
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Metadata
Title
Neurally adjusted ventilatory assist in patients with critical illness-associated polyneuromyopathy
Authors
Daniel Tuchscherer
Werner J. Z’Graggen
Christina Passath
Jukka Takala
Christer Sinderby
Lukas Brander
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 12/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2376-0

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