Abstract
BACKGROUND: Noninvasive ventilation (NIV) is commonly used in neonates. A mode of NIV called neurally adjusted ventilatory assist (NAVA) offers patient-ventilator interactions by using electrical activity of the diaphragm to control mechanical breaths. We hypothesized that the work of breathing (WOB) would decrease with NIV-NAVA. Secondary objectives evaluated the impact of NIV-NAVA on arterial blood gases and respiratory parameters.
METHODS: We compared WOB between synchronized breaths in NIV-NAVA and NIV in piglets with healthy lungs and then with surfactant-depleted lungs. Neonatal pigs (median, 2.0 [range, 1.8–2.4] kg) with healthy and then surfactant depleted lungs were sedated and ventilated with NIV-NAVA and NIV in random order. Airway flow and pressure waveforms were acquired. Waveforms were analyzed for the pressure-time product that reflected WOB. The primary outcome between modes was assessed with repeated measurement analysis of variance.
RESULTS: The pressure-time product was significantly decreased for NIV-NAVA in both healthy and injured lungs (P < .001). PaO2, PaCO2, inspiratory tidal volume, and peak inspiratory flow were not different in either model.
CONCLUSIONS: Synchronized breaths during NIV-NAVA resulted in decreased WOB compared with synchronized breaths during NIV.
- neurally adjusted ventilatory assist
- NAVA
- noninvasive ventilation
- work of breathing
- NIV
- respiratory physiology
Footnotes
- Correspondence: Sherry E Courtney MD, Arkansas Children's Hospital, One Children's Way, Slot 512-5 Little Rock, AR 72202. E-mail: scourtney{at}uams.edu.
Financial support was provided by a Children's University Medical Group institutional grant.
Dr Jones presented the data at the American Academy of Pediatrics National Conference and Exhibition, held October 22–25, 2016, in San Francisco, California; Hot Topics in Neonatology Conference, held December 5–7, 2016, in Washington DC; Diamond Conference, held April 28, 2017, in Little Rock, Arkansas.
The authors have disclosed no conflicts of interest.
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