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Neurally adjusted ventilatory assist in critically ill postoperative patients: a crossover randomized study
Yannael Coisel1, Gerald Chanques, Boris Jung
1Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier, France.
Anesthesiology
|September 9, 2010
Summary
Neurally adjusted ventilatory assist (NAVA) improved oxygenation in critically ill patients compared to pressure support ventilation (PSV). Greater respiratory variability with NAVA may contribute to enhanced patient oxygenation during mechanical ventilation weaning.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Neurally adjusted ventilatory assist (NAVA) is a novel mechanical ventilation mode.
- NAVA synchronizes ventilatory support with the patient's own neural respiratory drive.
- This study investigates NAVA's effects during the weaning phase in surgical ICU patients.
Purpose of the Study:
- To compare the ventilatory and gas exchange effects of NAVA versus pressure support ventilation (PSV).
- To evaluate NAVA's efficacy in critically ill patients undergoing mechanical ventilation weaning after surgery.
Main Methods:
- A randomized crossover study design was employed with 15 postsurgical ICU patients.
- Patients received 24 hours of NAVA and 24 hours of PSV.
- Ventilatory parameters, gas exchange, and respiratory variability were assessed.
Main Results:
- NAVA significantly improved the PaO2/FiO2 ratio compared to PSV (264 ± 71 vs. 230 ± 75 mmHg).
- Tidal volume was lower with NAVA (6.5 [6.3-7.4] ml/kg PBW) compared to PSV (7.0 [6.4-8.6] ml/kg PBW).
- NAVA demonstrated increased variability in airway pressure, tidal volume, and minute ventilation, but decreased diaphragmatic electrical activity variability.
Conclusions:
- NAVA enhanced patient oxygenation compared to PSV during the weaning phase.
- Increased respiratory system variability with NAVA may be a key factor in improving oxygenation.
- NAVA is a viable alternative to PSV for selected critically ill patients requiring mechanical ventilation.
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