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Neurally adjusted ventilatory assist improves patient-ventilator interaction

Piquilloud, Lise ; Vignaux, Laurence ; Bialais, Emilie ; Roeseler, Jean ; Sottiaux, Thierry ; Laterre, Pierre-François ; Jolliet, Philippe ; Tassaux, Didier

In: Intensive Care Medicine, 2011, vol. 37, no. 2, p. 263-271

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    Titre
    • Neurally adjusted ventilatory assist improves patient-ventilator interaction
    Auteur
    • Piquilloud, Lise. Intensive Care Unit, Clinical Research Laboratory, University Hospital, Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
    • Vignaux, Laurence. Intensive Care Unit, Clinical Research Laboratory, University Hospital, Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
    • Bialais, Emilie. Intensive Care Unit, University Hospital St.-Luc, Brussels, Belgium
    • Roeseler, Jean. Intensive Care Unit, University Hospital St.-Luc, Brussels, Belgium
    • Sottiaux, Thierry. Intensive Care Unit, Clinique Notre Dame de Grâce, Gosselies, Belgium
    • Laterre, Pierre-François. Intensive Care Unit, University Hospital St.-Luc, Brussels, Belgium
    • Jolliet, Philippe. Adult Intensive Care and Burn Unit, University Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
    • Tassaux, Didier. Intensive Care Unit, Clinical Research Laboratory, University Hospital, Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:319325
    Summary
    Purpose: To determine if, compared with pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces trigger delay, inspiratory time in excess, and the number of patient-ventilator asynchronies in intubated patients. Methods: Prospective interventional study in spontaneously breathing patients intubated for acute respiratory failure. Three consecutive periods of ventilation were applied: (1) PS1, (2) NAVA, (3) PS2. Airway pressure, flow, and transesophageal diaphragmatic electromyography were continuously recorded. Results: All results are reported as median (interquartile range, IQR). Twenty-two patients were included, 36.4% (8/22) having obstructive pulmonary disease. NAVA reduced trigger delay (ms): NAVA, 69 (57-85); PS1, 178 (139-245); PS2, 199 (135-256). NAVA improved expiratory synchrony: inspiratory time in excess (ms): NAVA, 126 (111-136); PS1, 204 (117-345); PS2, 220 (127-366). Total asynchrony events were reduced with NAVA (events/min): NAVA, 1.21 (0.54-3.36); PS1, 3.15 (1.18-6.40); PS2, 3.04 (1.22-5.31). The number of patients with asynchrony index (AI) >10% was reduced by 50% with NAVA. In contrast to PS, no ineffective effort or late cycling was observed with NAVA. There was less premature cycling with NAVA (events/min): NAVA, 0.00 (0.00-0.00); PS1, 0.14 (0.00-0.41); PS2, 0.00 (0.00-0.48). More double triggering was seen with NAVA, 0.78 (0.46-2.42); PS1, 0.00 (0.00-0.04); PS2, 0.00 (0.00-0.00). Conclusions: Compared with standard PS, NAVA can improve patient-ventilator synchrony in intubated spontaneously breathing intensive care patients. Further studies should aim to determine the clinical impact of this improved synchrony