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Optimizing patient-ventilator synchrony during invasive ventilator assist in children and infants remains a difficult

Laurence Vignaux1, Serge Grazioli, Lise Piquilloud

  • 11Cardio-respiratory Physiotherapy Department, University Hospital, Geneva, Switzerland. 2Peritox EA 4284-UMI01 INERIS, UPJV, Amiens, France. 3Neonatal and Pediatric Intensive Care Unit, University Hospital, Geneva, Switzerland. 4Intensive Care and Burns Unit, University Hospital, Lausanne, Switzerland. 5Pediatric Intensive Care Unit, University Hospital North, Amiens, France.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 12, 2013
PubMed

Insights

Neurally adjusted ventilatory assist significantly reduced mechanical ventilation asynchrony events in children compared to pressure support. This innovative approach offers a promising alternative for improving patient-ventilator synchrony in pediatric intensive care.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Asynchrony events are common during invasive-assisted mechanical ventilation in children.
  • Optimizing ventilator settings in pressure support mode can reduce, but not eliminate, these events.
  • Neurally adjusted ventilatory assist (NAVA) offers a potentially more synchronized ventilation mode.

Purpose of the Study:

  • To compare the prevalence of asynchrony events between pressure support (PS) and NAVA in intubated children.
  • To evaluate the impact of adjusting expiratory trigger settings in PS on asynchrony.
  • To quantify differences in trigger delay and inspiratory time excess between ventilation modes.

Main Methods:

  • A prospective, randomized, crossover study involving 19 intubated children (4 weeks to 5 years old).
  • Children received two ventilation periods: PS with optimized settings (PSbest) and NAVA, in random order.
  • Asynchrony events, trigger delay, and inspiratory time in excess were measured and compared.

Main Results:

  • Asynchrony events, including autotriggering and premature cycling, were significantly reduced in PSbest compared to initial PS settings (PSinit).
  • NAVA demonstrated a significant reduction in most asynchrony events compared to PSbest, achieving an asynchrony index of 3.8%.
  • NAVA resulted in an almost ten-fold reduction in asynchrony events compared to optimized pressure support.

Conclusions:

  • Asynchrony events are frequent in pediatric patients on pressure support ventilation, even with adjusted settings.
  • Neurally adjusted ventilatory assist significantly minimizes asynchrony events in children.
  • Further research is needed to determine the clinical implications of reduced asynchrony with NAVA.
Abstract

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