Abstract
BACKGROUND: After pediatric cardiac surgery, ventilation with high airway pressures can be detrimental to right ventricular function and pulmonary blood flow. Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interactions, helping maintain spontaneous ventilation. This study reports our experience with the use of NAVA in children after a cardiac surgery. We hypothesize that using NAVA in this population is feasible and allows for lower ventilation pressures.
METHODS: We retrospectively studied all children ventilated with NAVA (invasively or noninvasively) after undergoing cardiac surgery between January 2013 and May 2015 in our pediatric intensive care unit. The number and duration of NAVA episodes were described. For the first period of invasive NAVA in each subject, detailed clinical and ventilator data in the 4 h before and after the start of NAVA were extracted.
RESULTS: 33 postoperative courses were included in 28 subjects with a median age of 3 [interquartile range (IQR) 1–12] months. NAVA was used invasively in 27 courses for a total duration of 87 (IQR 15–334) h per course. Peak inspiratory pressures and mean airway pressures decreased significantly after the start of NAVA (mean differences of 5.8 cm H2O (95% CI 4.1–7.5) and 2.0 cm H2O (95% CI 1.2–2.8), respectively, P < .001 for both). There was no significant difference in vital signs or blood gas values. NAVA was used noninvasively in 14 subjects, over 79 (IQR 25–137) h.
CONCLUSIONS: NAVA could be used in pediatric subjects after cardiac surgery. The significant decrease in airway pressures observed after transition to NAVA could have a beneficial impact in this specific population, which should be investigated in future interventional studies.
- respiratory support
- noninvasive ventilation
- mechanical ventilation
- patient-ventilator interaction
- cardio-respiratory interaction
- patient-ventilator asynchrony
- pediatric
- cardiac surgery
Footnotes
- Correspondence: Guillaume Emeriaud MD PhD, CHU Sainte-Justine, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada. E-mail: guillaume.emeriaud{at}umontreal.ca.
Parts of the results of this study were presented by Benjamin Crulli at the 2016 Reanimation Congress, held January 13–15, 2016, in Paris, France.
Dr Emeriaud holds a Clinical Research Scholarship from the Fonds de la Recherche en Santé du Québec. He is also the principal investigator of an ongoing clinical study which is financially supported by Maquet Critical Care. He does not receive any salary nor any personal financial support from this company. The other authors have disclosed no conflicts of interest.
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