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Neurally Adjusted Ventilatory Assist in Preterm Infants With Established or Evolving Bronchopulmonary Dysplasia on

Young Hwa Jung1, Han-Suk Kim, Juyoung Lee

  • 11Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.2Department of Pediatrics, Inha University Hospital, Incheon, Korea.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|December 6, 2016
PubMed

Insights

Transitioning preterm infants with bronchopulmonary dysplasia to neurally adjusted ventilatory assist improved ventilator settings and blood gases. This suggests neurally adjusted ventilatory assist may be a useful weaning strategy for these vulnerable infants.

Area of Science:

  • Neonatology
  • Pediatric Critical Care
  • Respiratory Medicine

Background:

  • Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants requiring significant mechanical ventilatory support.
  • Conventional mechanical ventilation can lead to ventilator-induced lung injury and difficulties in weaning.
  • Neurally adjusted ventilatory assist (NAVA) offers a mode of ventilation that synchronizes with the infant's own respiratory drive.

Purpose of the Study:

  • To evaluate the impact of transitioning from synchronized intermittent mandatory ventilation (SIMV) to NAVA on ventilator parameters in preterm infants with BPD.
  • To assess changes in work of breathing and blood gas values following the switch to NAVA.
  • To explore the potential of NAVA as a weaning tool for BPD patients.

Main Methods:

  • A retrospective study was conducted in a neonatal intensive care unit (NICU).
  • Twenty-nine preterm infants with BPD requiring prolonged mechanical ventilation ( > 4 weeks) and high respiratory support were included.
  • Ventilator variables, work of breathing, and blood gas values were compared before and at various time points after conversion to NAVA.

Main Results:

  • The transition to NAVA resulted in significant reductions in peak inspiratory pressure, mean airway pressure, and work of breathing.
  • Blood gas values, including oxygenation and saturation, showed significant improvement after initiating NAVA.
  • Respiratory Severity Score (RSS) values decreased and were sustained during NAVA support.

Conclusions:

  • Switching to NAVA from SIMV in preterm infants with BPD is associated with improved ventilator efficiency and gas exchange.
  • NAVA demonstrates potential as a beneficial weaning strategy for infants suffering from BPD in the NICU.
  • Further research may confirm the clinical utility of NAVA in managing BPD.
Abstract

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