Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: A physiologic crossover study

Giorgia Spinazzola, Roberta Costa, Daniele De Luca, Giovanna Chidini, Giuliano Ferrone, Marco Piastra, Giorgio Conti

Research output: Contribution to journalArticle

Abstract

Background: Neurally adjusted ventilatory assist (NAVA) is an innovative mode for assisted ventilation that improves patient-ventilator interaction in children. The aim of this study was to assess the effects of patient-ventilator interaction comparing NAVA with pressure support ventilation (PSV) in patients difficult to wean from mechanical ventilation after moderate pediatric acute respiratory distress syndrome (PARDS). Methods: In this physiological crossover study, 12 patients admitted in the Pediatric Intensive Care Unit (PICU) with moderate PARDS failing up to 3 spontaneous breathing trials in less than 7 days, were enrolled. Patients underwent three study conditions lasting 1 h each: PSV1, NAVA and PSV2. Results: The Asynchrony Index (AI) was significantly reduced during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.001). During the NAVA trial, the inspiratory and expiratory trigger delays were significantly shorter compared to those obtained during PSV1 and PSV2 trials (Delaytrinsp p < 0.001, Delaytrexp p = 0.013). These results explain the significantly longer Timesync observed during the NAVA trial (p < 0.001). In terms of gas exchanges, PaO2 value significantly improved in the NAVA trial with respect to the PSV trials (p < 0.02). The PaO2/FiO2 ratio showed a significant improvement during the NAVA trial compared to both the PSV1 and PSV2 trials (p = 0.004). Conclusions: In this specific PICU population, presenting difficulty in weaning after PARDS, NAVA was associated with a reduction of the AI and a significant improvement in oxygenation compared to PSV mode. Trial registration: ClinicalTrial.gov Identifier: NCT04360590 "Retrospectively registered".

Original languageEnglish
Article number334
JournalBMC Pediatrics
Volume20
Issue number1
DOIs
Publication statusPublished - Jul 7 2020

Keywords

  • Mechanical ventilation
  • Neurally adjusted ventilatory assist
  • Patient-ventilator interaction
  • Pediatric acute respiratory distress syndrome
  • Weaning

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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