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NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand

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Moorhead, Katherine T. Piquilloud, Lise Lambermont, Bernard Roeseler, Jean [UCL] Chiew, Yeong Shiong Bialais, Emilie [UCL] Laterre, Pierre-François [UCL] Desaive, Thomas

Neurally adjusted ventilatory assist (NAVA) is a ventilation assist mode that delivers pressure in proportionality to electrical activity of the diaphragm (Eadi). Compared to pressure support ventilation (PS), it improves patient-ventilator synchrony and should allow a better expression of patient's intrinsic respiratory variability. We hypothesize that NAVA provides better matching in ventilator tidal volume (Vt) to patients inspiratory demand. 22 patients with acute respiratory failure, ventilated with PS were included in the study. A comparative study was carried out between PS and NAVA, with NAVA gain ensuring the same peak airway pressure as PS. Robust coefficients of variation (CVR) for Eadi and Vt were compared for each mode. The integral of Eadi (sh{phonetic}Eadi) was used to represent patient's inspiratory demand. To evaluate tidal volume and patient's demand matching, Range90 = 5-95 % range of the Vt/sh{phonetic}Eadi ratio was calculated, to normalize and compare differences in demand within and between patients and modes. In this study, peak Eadi and sh{phonetic}Eadi are correlated with median correlation of coefficients, R > 0.95. Median sh{phonetic}Eadi, Vt, neural inspiratory time (Ti_ Neural), inspiratory time (Ti) and peak inspiratory pressure (PIP) were similar in PS and NAVA. However, it was found that individual patients have higher or smaller sh{phonetic}Eadi, Vt, Ti_ Neural, Ti and PIP. CVR analysis showed greater Vt variability for NAVA (p < 0.005). Range90 was lower for NAVA than PS for 21 of 22 patients. NAVA provided better matching of Vt to sh{phonetic}Eadi for 21 of 22 patients, and provided greater variability Vt. These results were achieved regardless of differences in ventilatory demand (Eadi) between patients and modes. © 2012 Springer Science+Business Media New York.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2013
Language Anglais
Journal information "Journal of Clinical Monitoring and Computing" - Vol. 27, no. 1, p. 61-70 (2013)
Peer reviewed yes
Publisher Springer ((The Netherlands) Amsterdam)
issn 1387-1307
e-issn 1573-2614
Publication status Publié
Affiliations UCL - (SLuc) Service de soins intensifs
UCL - (SLuc) Service de médecine physique et de réadaptation motrice
UCL - SSS/IREC/MEDA - Pôle de médecine aiguë
UCL - (MGD) Services des soins intensifs
Keywords Matching ; Mechanical ventilation ; NAVA ; Patient-ventilator interaction ; Variability
Links
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Bibliographic reference Moorhead, Katherine T. ; Piquilloud, Lise ; Lambermont, Bernard ; Roeseler, Jean ; Chiew, Yeong Shiong ; et. al. NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand. In: Journal of Clinical Monitoring and Computing, Vol. 27, no. 1, p. 61-70 (2013)
Permanent URL http://hdl.handle.net/2078.1/122710