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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Tracheostomy | Research

Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy

Authors: Olivier Lamouret, Laure Crognier, Fanny Vardon Bounes, Jean-Marie Conil, Caroline Dilasser, Thibaut Raimondi, Stephanie Ruiz, Antoine Rouget, Clément Delmas, Thierry Seguin, Vincent Minville, Bernard Georges

Published in: Critical Care | Issue 1/2019

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Abstract

Background

Prolonged weaning is a major issue in intensive care patients and tracheostomy is one of the last resort options. Optimized patient-ventilator interaction is essential to weaning. The purpose of this study was to compare patient-ventilator synchrony between pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA) in a selected population of tracheostomised patients.

Methods

We performed a prospective, sequential, non-randomized and single-centre study. Two recording periods of 60 min of airway pressure, flow, and electrical activity of the diaphragm during PSV and NAVA were recorded in a random assignment and eight periods of 1 min were analysed for each mode. We searched for macro-asynchronies (ineffective, double, and auto-triggering) and micro-asynchronies (inspiratory trigger delay, premature, and late cycling). The number and type of asynchrony events per minute and asynchrony index (AI) were determined. The two respiratory phases were compared using the non-parametric Wilcoxon test after testing the equality of the two variances (F-Test).

Results

Among the 61 patients analysed, the total AI was lower in NAVA than in PSV mode: 2.1% vs 14% (p < 0.0001). This was mainly due to a decrease in the micro-asynchronies index: 0.35% vs 9.8% (p < 0.0001). The occurrence of macro-asynchronies was similar in both ventilator modes except for double triggering, which increased in NAVA. The tidal volume (ml/kg) was lower in NAVA than in PSV (5.8 vs 6.2, p < 0.001), and the respiratory rate was higher in NAVA than in PSV (28 vs 26, p < 0.05).

Conclusion

NAVA appears to be a promising ventilator mode in tracheotomised patients, especially for those requiring prolonged weaning due to the decrease in asynchronies.
Literature
1.
Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033–56.CrossRef
2.
Esteban A, Alía I, Ibañez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. Spanish Lung Failure Collaborative Group. Chest. 1994;106:1188–93.CrossRef
3.
Brochard L, Krauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994;150:896–903.CrossRef
4.
Langer M, Mosconi P, Cigada M, Mandelli M. Long-term respiratory support and risk of pneumonia in critically ill patients. Intensive Care Unit Group of Infection Control. Am Rev Respir Dis. 1989;140(2):302–5.CrossRef
5.
Chastre J, Fagon JY, et al. State of the Art. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867–903.CrossRef
6.
Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689–94.CrossRef
7.
Hosokawa K, Nishimura M, Egi M, Vincent J-L. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care. 2015;19:424.CrossRef
8.
Frutos-Vivar F, Esteban A, Apezteguia C, et al. Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med. 2005;33:290.CrossRef
9.
Combes A, Luyt CE, Nieszkowska A, Trouillet JL, Gibert C, Chastre J. Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation? Crit Care Med. 2007;35(3):802–7.CrossRef
10.
Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32:1515–22.CrossRef
11.
de Wit M, Miller KB, Green DA, Ostman HE, Gennings C, Epstein SK. Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med. 2009;37:2740–5.PubMed
12.
Branson RD, Blakeman TC, Robinson BRH. Asynchrony and dyspnea. Respir Care juin. 2013;58:973–89.CrossRef
13.
Piquilloud L, Vignaux L, Bialais E, Roeseler J, Sottiaux T, Laterre P-F, et al. Neurally adjusted ventilatory assist improves patient-ventilator interaction. Intensive Care Med. 2011;37:263–71.CrossRef
14.
Parthasarathy S, Jubran A, Tobin MJ. Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med. 1998;158:1471–8.CrossRef
15.
Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, et al. Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med. 2001;164:419–24.CrossRef
16.
Thille AW, Cabello B, Galia F, Lyazidi A, Brochard L. Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation. Intensive Care Med. 2008;34:1477–86.CrossRef
17.
Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L. Neural control of mechanical ventilation in respiratory failure. Nat Med. 1999;5:1433–6.CrossRef
18.
Spahija J, de Marchie M, Albert M, Bellemare P, Delisle S, Beck J, et al. Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med. 2010;38(2):518–26.CrossRef
19.
Terzi N, Pelieu I, Guittet L, Ramakers M, Seguin A, Daubin C, et al. Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: physiological evaluation. Crit Care Med. 2010;38(9):1830–7.CrossRef
20.
Mauri T, Bellani G, Grasselli G, Confalonieri A, Rona R, Patroniti N, et al. Patient-ventilator interaction in ARDS patients with extremely low compliance undergoing ECMO: a novel approach based on diaphragm electrical activity. Intensive Care Med. 2013;39(2):282–91.CrossRef
21.
Yonis H, Crognier L, Conil J-M, Serres I, Rouget A, Virtos M, et al. Patient-ventilator synchrony in neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV): a prospective observational study. BMC Anesthesiol. 2015;15:117.CrossRef
22.
Kuo NY, Tu ML, Hung TY, Liu SF, Chung YH, Lin MC, Wu CC. A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation. Int J Chron Obstruct Pulmon Dis. 2016;11:945–51.CrossRef
23.
Vagheggini SM, Panai EV, Navalesi P, Ambrosino N. Physiologic response to various levels of pressure support and NAVA in prolonged weaning. Respir Med. 2013;107:1748–54.CrossRef
24.
Whitelaw WA, Derenne JP, Milic-Emili J. Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol. 1975;23(2):181–99.CrossRef
25.
Dres M, Dube BP, Mayaux J, Delemazure J, Reuter D, Brochard L, Similowski T, Demoule A. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med. 2017;195:57–66.CrossRef
26.
Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M. Patient–ventilator trigger asynchrony in prolonged mechanical ventilation. Chest. 1997;112:1592–9.CrossRef
27.
Piquilloud L, Tassaux D, Bialais E, et al. Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask. Intensive Care Med. 2012;38:1624–31.CrossRef
28.
Blanch L, Villagra A, Sales B, Montanya J, Lucangelo U, Lujan M, Garcia-Esquirol O, Chacon E, Estruga A, Oliva JC, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41(4):633–41. https://​doi.​org/​10.​1007/​s00134-015-3692-6.
29.
Demoule A, Clavel M, Rolland-Debord C, Perbet S, Terzi N, Kouatchet A, Wallet F, Roze H, Vargas F, Guerin C, Dellamonica J, Jaber S, Brochard L, Similowski T. Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial. Intensive Care Med. 2016;42(11):1723–32.CrossRef
30.
Colombo D, Cammarota G, Bergamaschi V, De Lucia M, Corte FD, Navalesi P. Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med. 2008;34:2010–8.CrossRef
Metadata
Title
Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
Authors
Olivier Lamouret
Laure Crognier
Fanny Vardon Bounes
Jean-Marie Conil
Caroline Dilasser
Thibaut Raimondi
Stephanie Ruiz
Antoine Rouget
Clément Delmas
Thierry Seguin
Vincent Minville
Bernard Georges
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Tracheostomy
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2288-2

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