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Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy

BACKGROUND: Prolonged weaning is a major issue in intensive care patients and tracheostomy is one of the last resort options. Optimized patient-ventilator interaction is essential to weaning. The purpose of this study was to compare patient-ventilator synchrony between pressure support ventilation (...

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Autores principales: Lamouret, Olivier, Crognier, Laure, Bounes, Fanny Vardon, Conil, Jean-Marie, Dilasser, Caroline, Raimondi, Thibaut, Ruiz, Stephanie, Rouget, Antoine, Delmas, Clément, Seguin, Thierry, Minville, Vincent, Georges, Bernard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323755/
https://www.ncbi.nlm.nih.gov/pubmed/30616669
http://dx.doi.org/10.1186/s13054-018-2288-2
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author Lamouret, Olivier
Crognier, Laure
Bounes, Fanny Vardon
Conil, Jean-Marie
Dilasser, Caroline
Raimondi, Thibaut
Ruiz, Stephanie
Rouget, Antoine
Delmas, Clément
Seguin, Thierry
Minville, Vincent
Georges, Bernard
author_facet Lamouret, Olivier
Crognier, Laure
Bounes, Fanny Vardon
Conil, Jean-Marie
Dilasser, Caroline
Raimondi, Thibaut
Ruiz, Stephanie
Rouget, Antoine
Delmas, Clément
Seguin, Thierry
Minville, Vincent
Georges, Bernard
author_sort Lamouret, Olivier
collection PubMed
description BACKGROUND: Prolonged weaning is a major issue in intensive care patients and tracheostomy is one of the last resort options. Optimized patient-ventilator interaction is essential to weaning. The purpose of this study was to compare patient-ventilator synchrony between pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA) in a selected population of tracheostomised patients. METHODS: We performed a prospective, sequential, non-randomized and single-centre study. Two recording periods of 60 min of airway pressure, flow, and electrical activity of the diaphragm during PSV and NAVA were recorded in a random assignment and eight periods of 1 min were analysed for each mode. We searched for macro-asynchronies (ineffective, double, and auto-triggering) and micro-asynchronies (inspiratory trigger delay, premature, and late cycling). The number and type of asynchrony events per minute and asynchrony index (AI) were determined. The two respiratory phases were compared using the non-parametric Wilcoxon test after testing the equality of the two variances (F-Test). RESULTS: Among the 61 patients analysed, the total AI was lower in NAVA than in PSV mode: 2.1% vs 14% (p < 0.0001). This was mainly due to a decrease in the micro-asynchronies index: 0.35% vs 9.8% (p < 0.0001). The occurrence of macro-asynchronies was similar in both ventilator modes except for double triggering, which increased in NAVA. The tidal volume (ml/kg) was lower in NAVA than in PSV (5.8 vs 6.2, p < 0.001), and the respiratory rate was higher in NAVA than in PSV (28 vs 26, p < 0.05). CONCLUSION: NAVA appears to be a promising ventilator mode in tracheotomised patients, especially for those requiring prolonged weaning due to the decrease in asynchronies.
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spelling pubmed-63237552019-01-10 Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy Lamouret, Olivier Crognier, Laure Bounes, Fanny Vardon Conil, Jean-Marie Dilasser, Caroline Raimondi, Thibaut Ruiz, Stephanie Rouget, Antoine Delmas, Clément Seguin, Thierry Minville, Vincent Georges, Bernard Crit Care Research BACKGROUND: Prolonged weaning is a major issue in intensive care patients and tracheostomy is one of the last resort options. Optimized patient-ventilator interaction is essential to weaning. The purpose of this study was to compare patient-ventilator synchrony between pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA) in a selected population of tracheostomised patients. METHODS: We performed a prospective, sequential, non-randomized and single-centre study. Two recording periods of 60 min of airway pressure, flow, and electrical activity of the diaphragm during PSV and NAVA were recorded in a random assignment and eight periods of 1 min were analysed for each mode. We searched for macro-asynchronies (ineffective, double, and auto-triggering) and micro-asynchronies (inspiratory trigger delay, premature, and late cycling). The number and type of asynchrony events per minute and asynchrony index (AI) were determined. The two respiratory phases were compared using the non-parametric Wilcoxon test after testing the equality of the two variances (F-Test). RESULTS: Among the 61 patients analysed, the total AI was lower in NAVA than in PSV mode: 2.1% vs 14% (p < 0.0001). This was mainly due to a decrease in the micro-asynchronies index: 0.35% vs 9.8% (p < 0.0001). The occurrence of macro-asynchronies was similar in both ventilator modes except for double triggering, which increased in NAVA. The tidal volume (ml/kg) was lower in NAVA than in PSV (5.8 vs 6.2, p < 0.001), and the respiratory rate was higher in NAVA than in PSV (28 vs 26, p < 0.05). CONCLUSION: NAVA appears to be a promising ventilator mode in tracheotomised patients, especially for those requiring prolonged weaning due to the decrease in asynchronies. BioMed Central 2019-01-07 /pmc/articles/PMC6323755/ /pubmed/30616669 http://dx.doi.org/10.1186/s13054-018-2288-2 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Lamouret, Olivier
Crognier, Laure
Bounes, Fanny Vardon
Conil, Jean-Marie
Dilasser, Caroline
Raimondi, Thibaut
Ruiz, Stephanie
Rouget, Antoine
Delmas, Clément
Seguin, Thierry
Minville, Vincent
Georges, Bernard
Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
title Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
title_full Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
title_fullStr Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
title_full_unstemmed Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
title_short Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
title_sort neurally adjusted ventilatory assist (nava) versus pressure support ventilation: patient-ventilator interaction during invasive ventilation delivered by tracheostomy
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323755/
https://www.ncbi.nlm.nih.gov/pubmed/30616669
http://dx.doi.org/10.1186/s13054-018-2288-2
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