TY - JOUR T1 - Neurally-Adjusted Ventilatory Assist for Noninvasive Ventilation via a Helmet in Subjects With COPD Exacerbation: A Physiologic Study JF - Respiratory Care DO - 10.4187/respcare.06502 SP - respcare.06502 AU - Federico Longhini AU - Ling Liu AU - Chun Pan AU - Jianfeng Xie AU - Gianmaria Cammarota AU - Andrea Bruni AU - Eugenio Garofalo AU - Yi Yang AU - Paolo Navalesi AU - Haibo Qiu Y1 - 2019/02/12 UR - http://rc.rcjournal.com/content/early/2019/02/12/respcare.06502.abstract N2 - Background: In patients with COPD exacerbation, noninvasive ventilation (NIV) is strongly recommended. NIV is generally delivered by using pneumatically triggered and cycled pressure support through a face mask. A specific method to generate neurally-controlled pressure support has been shown to improve comfort and patient-ventilator interaction. In addition, the helmet interface was better tolerated by patients compared with a face mask. Herein, we compared neurally-controlled pressure support through a helmet with pressure support through a face mask with respect to subject comfort, breathing pattern, gas exchange, pressurization and triggering performance, and patient-ventilator synchrony.Methods: Two 30-min trials of NIV were randomly delivered to 10 subjects with COPD exacerbation redundant: (1) pressure support through a face mask with inspiratory pressure support of ≤8cmH2O to obtain a tidal volume of 6–8 mL/kg of ideal body weight; and (2) NAVA through a helmet, setting the neurally-adjusted ventilatory assist level at 15 cm H2O/μV, with an upper airway pressure limit to obtain the same overall airway pressure applied during pressure support through a face mask. We assessed subject comfort, breathing frequency, respiratory drive, arterial blood gases, pressure-time product (PTP) of the first 300 ms and 500ms after initiation of subject effort, inspiratory trigger delay, and rate of asynchrony determined as the asynchrony index.Results: Median and interquartile range NAVA through a helmet improved comfort (7.0 [6.0 – 8.0]) compared with pressure support through a face mask (5.0 [4.7–5.2], P = .005). The breathing pattern was not different between the methods. Respiratory drive was slightly, although not significantly, reduced (P = .19) during NAVA through a helmet in comparison with pressure support through a face mask. Gas exchange was also not different between the trials. The PTP of the first 300 ms (P = .92) and PTP of the first 500 ms (P = .08) were not statistically different between trials, whereas triggering performance, patient-ventilator interaction, and synchrony were all improved by NAVA through a helmet compared with pressure support through a face mask.Conclusions: In the subjects with COPD with exacerbation, NAVA through a helmet improved comfort, triggering performance, and patient-ventilator synchrony compared with pressure support through a face mask. ER -