Non-invasive neurally adjusted ventilatory assist in preterm infants: a randomised phase II crossover trial. Issue 6 (15th July 2015)

• Record Type: Journal Article
• Authors: Lee, Juyoung; Kim, Han-Suk; Jung, Young Hwa; Shin, Seung Han; Choi, Chang Won; Kim, Ee-Kyung; Kim, Beyong Il; Choi, Jung-Hwan
• Is Part Of: Archives of disease in childhood. Volume 100:Issue 6(2015)
• Page Start: F507
• Page End: F513
• Publication Date: 2015-07-15
• Subjects: Intensive Care -- Neonatology -- Respiratory; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2014-308057
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objective: To compare non-invasive ventilation neurally adjusted ventilatory assist (NIV-NAVA) and non-invasive pressure support (NIV-PS) in preterm infants on patient–ventilator synchrony. Design: A randomised phase II crossover trial. Setting: Neonatal intensive care units of two tertiary university hospitals in Korea. Patients: Preterm infants born <32 weeks. Intervention: NIV-NAVA and NIV-PS were applied in random order after ventilator weaning. Data were recorded for sequential 5 min periods after 10 min applications of each mode. Main outcome measures: The electrical activity of the diaphragm (Edi), ventilator flow and pressure curves were compared to examine the trigger delay (primary outcome) and other parameters of patient–ventilator interaction (secondary outcomes) for each period. Results: Fifteen infants completed the protocol. Trigger delay (35.2±8.3 vs 294.6±101.9 ms, p<0.001), ventilator inspiratory time (423.3±87.1 vs 534.0±165.5 ms, p=0.009) and inspiratory time in excess (32.3±8.3% vs 294.6±101.9%, p=0.001) were lower during NIV-NAVA compared with NIV-PS. Maximum Edi (12.6±6.3 vs 16.6±8.7 μV, p=0.003), swing Edi (8.8±4.8 vs 12.2±8.7 μV, p=0.012) and peak inspiratory pressure (12.3±1.5 vs 14.7±2.7 cm H2 O, p=0.003) were also lower during NIV-NAVA. The main asynchrony events during NIV-PS were ineffective efforts and autotriggering. All types of asynchronies except double triggering were reduced with NIV-NAVA. Asynchrony index was significantly lower during NIV-NAVA compared with NIV-PS (p<0.001). No significant differences in leakage, expiratory tidal volume or minute ventilation were observed, but the respiratory rate was lower during NIV-PS than during NIV-NAVA. Conclusions: NAVA improved patient–ventilator synchrony and diaphragmatic unloading in preterm infants during non-invasive nasal ventilation even in the presence of large air leaks. Trial registration number: Registered with http://www.clinicaltrials.gov (NCT01877720 ).