Top

Intensive Care Medicine

Published in:

01-02-2008 | Original

Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury

Authors: Jennifer Beck, Lukas Brander, Arthur S. Slutsky, Maureen C. Reilly, Michael S. Dunn, Christer Sinderby

Published in: Intensive Care Medicine | Issue 2/2008

Abstract

Objective

Neurally adjusted ventilatory assist uses the electrical activity of the diaphragm (EAdi)—a pneumatically-independent signal—to control the timing and pressure of the ventilation delivered, and should not be affected by leaks. The aim of this study was to evaluate whether NAVA can deliver assist in synchrony and proportionally to EAdi after extubation, with a leaky non-invasive interface.

Design and setting

Prospective, controlled experimental study in an animal laboratory.

Animals

Ten rabbits, anesthetized, mechanically ventilated.

Interventions

Following lung injury, the following was performed in sequential order: (1) NAVA delivered via oral endotracheal tube with PEEP; (2) same as (1) without PEEP; (3) non-invasive NAVA at unchanged NAVA level and no PEEP via a single nasal prong; (4) no assist; (5) non-invasive NAVA at progressively increasing NAVA levels.

Measurements and results

EAdi, esophageal pressure, blood gases and hemodynamics were measured during each condition. For the same NAVA level, the mean delivered pressure above PEEP increased from 3.9 ± 1.4 cmH₂O (intubated) to 7.5 ± 3.8 cmH₂O (non-invasive) (p < 0.05) because of increased EAdi. No changes were observed in PaO₂ and PaCO₂. Increasing the NAVA level fourfold during non-invasive NAVA restored EAdi and esophageal pressure swings to pre-extubation levels. Triggering (106 ± 20 ms) and cycling-off delays (40 ± 21 ms) during intubation were minimal and not worsened by the leak (95 ± 13 ms and 33 ± 9 ms, respectively).

Conclusion

NAVA can be effective in delivering non-invasive ventilation even when the interface with the patient is excessively leaky, and can unload the respiratory muscles while maintaining synchrony with the subject's demand.

Available only for authorised users

Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, Sinderby C (2001) Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 164:419–424PubMed

Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient–ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522PubMedCrossRef

Beck J, Tucci M, Emeriaud G, Lacroix J, Sinderby C (2004) Prolonged neural expiratory time induced by mechanical ventilation in infants. Pediatr Res 55:747–754PubMedCrossRef

Stark AR, Bascom R, Frantz ID III (1979) Muscle relaxation in mechanically ventilated infants. J Pediatr 94:439–443PubMedCrossRef

Henry GW, Stevens DC, Schreiner RL, Grosfeld JL, Ballantine TV (1979) Respiratory paralysis to improve oxygenation and mortality in large newborn infants with respiratory distress. J Pediatr Surg 14:761–767PubMedCrossRef

Greenough A, Wood S, Morley CJ, Davis JA (1984) Pancuronium prevents pneumothoraces in ventilated premature babies who actively expire against positive pressure inflation. Lancet 1:1–3PubMedCrossRef

Tremblay LN, Slutsky AS (1998) Ventilator-induced injury: from barotrauma to biotrauma. Proc Assoc Am Physicians 110:482–488PubMed

Greenough A, Morley C, Davis J (1983) Interaction of spontaneous respiration with artificial ventilation in preterm babies. J Pediatr 103:769–773PubMedCrossRef

Younes M, Kun J, Webster K, Roberts D (2002) Response of ventilator-dependent patients to delayed opening of exhalation valve. Am J Respir Crit Care Med 166:21–30PubMedCrossRef

10.

Kondili E, Prinianakis G, Anastasaki M, Georgopoulos D (2001) Acute effects of ventilator settings on respiratory motor output in patients with acute lung injury. Intensive Care Med 27:1147–1157PubMedCrossRef

11.

Essouri S, Nicot F, Clement A, Garabedian EN, Roger G, Lofaso F, Fauroux B (2005) Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure. Intensive Care Med 31:574–580PubMedCrossRef

12.

Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C (1999) Patient–ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intensive Care Med 25:662–667PubMedCrossRef

13.

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

14.

Lourenco RV, Cherniack NS, Malm JR, Fishman AP (1966) Nervous output from the respiratory center during obstructed breathing. J Appl Physiol 21:527–533PubMed

15.

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

16.

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

17.

Beck J, Brander L, Allo JC, Brunet F, Slutsky AS, Reilly MC, Dunn MS, Sinderby C (2005) Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury. Proceedings of the American Thoracic Society (PATS) 2(abstracts issue):A847

18.

Tran HS, Puc MM, Tran JL, Del Rossi AJ, Hewitt CW (2001) A method of endoscopic endotracheal intubation in rabbits. Lab Anim 35:249–252PubMedCrossRef

19.

Franz AR, Mack C, Reichart J, Pohlandt F, Hummler HD (2001) Preserved spontaneous breathing improves cardiac output during partial liquid ventilation. Am J Respir Crit Care Med 164:36–42PubMed

20.

Barrington KJ, Bull D, Finer NN (2001) Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics 107:638–641PubMedCrossRef

21.

Al Hathlol K, Idiong N, Hussain A, Kwiatkowski K, Alvaro RE, Weintraub Z, Cates DB, Rigatto H (2000) A study of breathing pattern and ventilation in newborn infants and adult subjects. Acta Paediatr 89:1420–1425PubMedCrossRef

22.

Upton CJ, Milner AD, Stokes GM (1990) The effect of changes in inspiratory time on neonatal triggered ventilation. Eur J Pediatr 149:648–650PubMedCrossRef

23.

Schulze A, Suguihara C, Gerhardt T, Schaller P, Claure N, Everett R, Bancalari E (1998) Effects of respiratory mechanical unloading on thoracoabdominal motion in meconium-injured piglets and rabbits. Pediatr Res 43:191–197PubMedCrossRef

24.

Hird MF, Greenough A (1991) Spontaneous respiratory effort during mechanical ventilation in infants with and without acute respiratory distress. Early Hum Dev 25:69–73PubMedCrossRef

25.

Abdel-Hady H, Mohareb S, Khashaba M, Abu-Alkhair M, Greisen G (1998) Randomized controlled trial of discontinuation of nasal-CPAP in stable preterm infants breathing room air. Acta Paediatr 87:82–87PubMedCrossRef

26.

Garland JS, Nelson DB, Rice T, Neu J (1985) Increased risk of gastrointestinal perforations in neonates mechanically ventilated with either face mask or nasal prongs. Pediatrics 76:406–410PubMed

27.

Moreau-Bussiere F, Samson N, St Hilaire M, Reix P, Lafond JR, Nsegbe E, Praud JP (2007) Laryngeal response to nasal ventilation in nonsedated newborn lambs. J Appl Physiol 102:2149–2157PubMedCrossRef

28.

Hutchison AA, Wozniak JA (2000) Endotracheal measurement of thyroarytenoid activity in newborn lambs. Biol Neonate 78:139–144PubMedCrossRef

29.

Emeriaud G, Beck J, Tucci M, Lacroix J, Sinderby C (2006) Diaphragm electrical activity during expiration in mechanically ventilated infants. Pediatr Res 59:705–710PubMedCrossRef

30.

Brackenbury AM, Puligandla PS, McCaig LA, Nikore V, Yao LJ, Veldhuizen RA, Lewis JF (2001) Evaluation of exogenous surfactant in HCL-induced lung injury. Am J Respir Crit Care Med 163:1135–1142PubMed

31.

Imai Y, Parodo J, Kajikawa O, de Perrot M, Fischer S, Edwards V, Cutz E, Liu M, Keshavjee S, Martin TR, Marshall JC, Ranieri VM, Slutsky AS (2003) Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA 289:2104–2112PubMedCrossRef

Title: Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury
Authors: Jennifer Beck
Lukas Brander
Arthur S. Slutsky
Maureen C. Reilly
Michael S. Dunn
Christer Sinderby
Publication date: 01-02-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0882-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury

Abstract

Objective

Design and setting

Animals

Interventions

Measurements and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Animals

Interventions

Measurements and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2008

Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study

Do antibiotics administered at the time of central venous catheter removal interfere with the evaluation of colonization?

Pattern of inspiratory gas delivery affects CO2 elimination in health and after acute lung injury

Certification and training in critical care ultrasound

Short-term beneficial effects of methylene blue on kidney damage in septic shock patients

An assessment of the validity of spectral entropy as a measure of sedation statein mechanically ventilated critically ill patients