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Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure

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Abstract

Objective

Neurally adjusted ventilatory assist (NAVA) is a new mode wherein the assistance is provided in proportion to diaphragm electrical activity (EAdi). We assessed the physiologic response to varying levels of NAVA and pressure support ventilation (PSV).

Setting

ICU of a University Hospital.

Patients

Fourteen intubated and mechanically ventilated patients.

Design and protocol

Cross-over, prospective, randomized controlled trial. PSV was set to obtain a V t/kg of 6–8 ml/kg with an active inspiration. NAVA was matched with a dedicated software. The assistance was decreased and increased by 50% with both modes. The six assist levels were randomly applied.

Measurements

Arterial blood gases (ABGs), tidal volume (V t/kg), peak EAdi, airway pressure (Paw), neural and flow-based timing. Asynchrony was calculated using the asynchrony index (AI).

Results

There was no difference in ABGs regardless of mode and assist level. The differences in breathing pattern, ventilator assistance, and respiratory drive and timing between PSV and NAVA were overall small at the two lower assist levels. At the highest assist level, however, we found greater V t/kg (9.1 ± 2.2 vs. 7.1 ± 2 ml/kg, P < 0.001), and lower breathing frequency (12 ± 6 vs. 18 ± 8.2, P < 0.001) and peak EAdi (8.6 ± 10.5 vs. 12.3 ± 9.0, P < 0.002) in PSV than in NAVA; we found mismatch between neural and flow-based timing in PSV, but not in NAVA. AI exceeded 10% in five (36%) and no (0%) patients with PSV and NAVA, respectively (P < 0.05).

Conclusions

Compared to PSV, NAVA averted the risk of over-assistance, avoided patient–ventilator asynchrony, and improved patient–ventilator interaction.

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Acknowledgments

We thank Maquet Critical Care that provided us with all the equipment used for the study. We are indebted to Jeffrey Franc-Law who carefully revised the manuscript. Last but not least, we wish to acknowledge all physicians and nurses of our Intensive Care Unit for their helpful and continuous support.

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Authors and Affiliations

  1. Università degli Studi del Piemonte Orientale “A. Avogadro”, SCDU Anestesia, Terapia Intensiva e Rianimazione Generale, Azienda Ospedaliera Universitaria “Maggiore della Carità”, C.so Mazzini 18, 28100, Novara, Italy

    Davide Colombo, Gianmaria Cammarota, Valentina Bergamaschi, Marta De Lucia, Francesco Della Corte & Paolo Navalesi

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  1. Davide Colombo
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  2. Gianmaria Cammarota
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  3. Valentina Bergamaschi
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  4. Marta De Lucia
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  5. Francesco Della Corte
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  6. Paolo Navalesi
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Corresponding author

Correspondence to Paolo Navalesi.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-008-1215-4.

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Colombo, D., Cammarota, G., Bergamaschi, V. et al. Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 34, 2010–2018 (2008). https://doi.org/10.1007/s00134-008-1208-3

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  • DOI: https://doi.org/10.1007/s00134-008-1208-3

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