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

01-12-2011 | Original

Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation

Authors: Gianmaria Cammarota, Carlo Olivieri, Roberta Costa, Rosanna Vaschetto, Davide Colombo, Emilia Turucz, Federico Longhini, Francesco Della Corte, Giorgio Conti, Paolo Navalesi

Published in: Intensive Care Medicine | Issue 12/2011

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Abstract

Purpose

Neurally adjusted ventilatory assist (NAVA) has been shown to improve patient–ventilator interaction and reduce asynchronies in intubated patients, as opposed to pressure support ventilation (PSV). This is a short-term head-to-head physiologic comparison between PSV and NAVA in delivering noninvasive ventilation through a helmet (h-NIV), in patients with postextubation hypoxemic acute respiratory failure.

Methods

Ten patients underwent three 20-min trials of h-NIV in PSV, NAVA, and PSV again. Arterial blood gases (ABGs) were assessed at the end of each trial. Diaphragm electrical activity (EAdi) and airway pressure (P aw) were recorded to derive neural and mechanical respiratory rate and timing, inspiratory (delayTR-insp) and expiratory trigger delays (delayTR-exp), time of synchrony between diaphragm contraction and ventilator assistance (timesynch), and the asynchrony index (AI).

Results

ABGs, peak EAdi, peak P aw, respiratory rate, either neural or mechanical, neural timing, and delayTR-exp were not different between trials. Compared with PSV, with NAVA the mechanical expiratory time was significantly shorter, while the inspiratory time and duty cycle were greater. Timesynch was 0.79 ± 0.35 s in NAVA versus 0.60 ± 0.30 s and 0.55 ± 0.29 s during the PSV trials (p < 0.01 for both). AI exceeded 10% during both PSV trials, while not in NAVA (p < 0.001).

Conclusions

Compared with PSV, NAVA improves patient–ventilator interaction and synchrony, with no difference in gas exchange, respiratory rate, and neural drive and timing.
Appendix
Available only for authorised users
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Metadata
Title
Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation
Authors
Gianmaria Cammarota
Carlo Olivieri
Roberta Costa
Rosanna Vaschetto
Davide Colombo
Emilia Turucz
Federico Longhini
Francesco Della Corte
Giorgio Conti
Paolo Navalesi
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/s00134-011-2382-2

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