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Early Noninvasive Neurally Adjusted Ventilatory Assist Versus Noninvasive Flow-Triggered Pressure Support Ventilation
Giovanna Chidini1, Daniele De Luca, Giorgio Conti
11Pediatric Intensive Care Unit, Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.2Division of Pediatric and Neonatal Critical Care, South Paris University Hospital, Medical Centers "A. Beclere" Assistance Publique-Hopitaux de Paris (APHP), Paris, France.3Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy.4Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, Genova, Italy.5Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Objective:
Neurally adjusted ventilatory assist has been shown to improve patient-ventilator interaction in children with acute respiratory failure. Objective of this study was to compare the effect of noninvasive neurally adjusted ventilatory assist versus noninvasive flow-triggered pressure support on patient-ventilator interaction in children with acute respiratory failure, when delivered as a first-line respiratory support.
Design:
Prospective randomized crossover physiologic study.
Setting:
Pediatric six-bed third-level PICU.
Patients:
Eighteen children with acute respiratory failure needing noninvasive ventilation were enrolled at PICU admission.
Interventions:
Enrolled children were allocated to receive two 60-minutes noninvasive flow-triggered pressure support and noninvasive neurally adjusted ventilatory assist trials in a crossover randomized sequence.
Measurements And Main Results:
Primary endpoint was the asynchrony index. Parameters describing patient-ventilator interaction and gas exchange were also considered as secondary endpoints. Noninvasive neurally adjusted ventilatory assist compared to noninvasive flow-triggered pressure support: 1) reduced asynchrony index (p = 0.001) and the number of asynchronies per minute for each type of asynchrony; 2) it increased the neuroventilatory efficiency index (p = 0.001), suggesting better neuroventilatory coupling; 3) reduced inspiratory and expiratory delay times (p = 0.001) as well as lower peak and mean airway pressure (p = 0.006 and p = 0.038, respectively); 4) lowered oxygenation index (p = 0.043). No adverse event was reported.
Conclusions:
In children with mild early acute respiratory failure, noninvasive neurally adjusted ventilatory assist was feasible and safe. Noninvasive neurally adjusted ventilatory assist compared to noninvasive flow-triggered pressure support improved patient-ventilator interaction.
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