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Patient-ventilator asynchrony during noninvasive pressure support ventilation and neurally adjusted ventilatory

Laurence Vignaux1, Serge Grazioli, Lise Piquilloud

  • 11Adult Cardio-respiratory Physiotherapy, La Tour Hospital, Geneva, Switzerland. 2Medicine UFR, University of Picardie Jules Verne, Peritox EA 4284-UMI01 INERIS, 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 19, 2013
PubMed

Insights

Neurally adjusted ventilatory assist significantly reduces patient-ventilator asynchrony in infants and children compared to pressure support. This method improves synchrony by decreasing trigger delay and overall asynchrony events during noninvasive ventilation.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Mechanical ventilation

Background:

  • Patient-ventilator asynchrony is a common issue during noninvasive ventilation (NIV) in pediatric patients.
  • Optimizing ventilator settings is crucial for improving synchrony and patient outcomes.

Purpose of the Study:

  • To evaluate the prevalence of asynchrony events during NIV in infants and children using pressure support (PS).
  • To compare the efficacy of PS with neurally adjusted ventilatory assist (NAVA) in reducing asynchrony.

Main Methods:

  • A prospective randomized cross-over study was conducted in a pediatric intensive care unit.
  • Infants and children (4 weeks to 5 years) underwent two ventilation periods: PS with optimized expiratory trigger settings (PSbest) and NAVA.
  • Asynchrony events, trigger delay, and cycling-off delay were quantified.

Main Results:

  • NAVA significantly reduced trigger delay compared to both initial (PSinit) and optimized (PSbest) pressure support.
  • The asynchrony index was significantly lower with NAVA (2.3%) compared to PSinit (65.5%) and PSbest (40%).
  • NAVA reduced most types of asynchronies, while PSbest showed a trend towards less premature cycling than PSinit.

Conclusions:

  • Asynchrony events are frequent during pressure support NIV in pediatric patients.
  • Neurally adjusted ventilatory assist demonstrates superior patient-ventilator synchrony compared to pressure support.
  • Further research is needed to determine the clinical implications of improved synchrony with NAVA.
Abstract

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