Neurally adjusted ventilatory assist in ventilated very preterm infants: A crossover study

Area of Science:

• Neonatal Medicine
• Pediatric Respiratory Care
• Mechanical Ventilation

Background:

• Preterm infants often require mechanical ventilation due to immature respiratory systems.
• Conventional ventilation methods may lead to lung injury and suboptimal gas exchange.
• Neurally adjusted ventilatory assist (NAVA) offers a potential alternative by synchronizing ventilator support with the infant's own respiratory drive.

Purpose of the Study:

• To evaluate the impact of NAVA ventilation on oxygenation and key respiratory parameters in very preterm infants.
• To compare the efficacy of NAVA versus conventional ventilation in maintaining target saturation levels and minimizing respiratory events.

Main Methods:

• An observational crossover study was conducted involving 19 preterm infants (born before 30 gestational weeks).
• Infants received both NAVA and conventional ventilation for 3-hour periods.
• Parameters assessed included peripheral and cerebral oxygen saturation (SpO2, cRSO2), desaturation episodes, electrical activity of the diaphragm (Edi), neural respiratory rates, and peak inspiratory pressures (PIPs).

Main Results:

• NAVA ventilation did not significantly alter the proportion of time SpO2 and cRSO2 remained within target ranges.
• However, NAVA was associated with a lower desaturation severity index and fewer manual oxygen adjustments compared to conventional ventilation.
• Mean Edi and PIP values were significantly lower during NAVA support, indicating reduced respiratory effort and pressure.

Conclusions:

• NAVA ventilation in very preterm infants is linked to reduced diaphragmatic activity and lower peak inspiratory pressures.
• While not improving time in target saturation, NAVA demonstrated benefits in mitigating the severity of hypoxemic events and decreasing the need for supplemental oxygen adjustments.
• NAVA represents a promising ventilation strategy for improving respiratory support and reducing complications in extremely premature neonates.