PT  - JOURNAL ARTICLE
AU  - Prasad, Kuruswamy Thurai
AU  - Gandra, Raghava Rao
AU  - Dhooria, Sahajal
AU  - Muthu, Valliappan
AU  - Aggarwal, Ashutosh Nath
AU  - Agarwal, Ritesh
AU  - Sehgal, Inderpaul Singh
TI  - Comparing Noninvasive Ventilation Delivered Using Neurally-Adjusted Ventilatory Assist or Pressure Support in Acute Respiratory Failure
AID  - 10.4187/respcare.07952
DP  - 2020 Sep 01
TA  - Respiratory Care
PG  - respcare.07952
4099  - http://rc.rcjournal.com/content/early/2020/09/01/respcare.07952.short
4100  - http://rc.rcjournal.com/content/early/2020/09/01/respcare.07952.full
AB  - BACKGROUND: The use of neurally-adjusted ventilatory assist (NAVA) during noninvasive ventilation (NIV) results in better patient–ventilator interaction. Whether this improves clinical outcomes lacks dedicated study.METHODS: In this randomized controlled trial, we compared NAVA with PSV for delivering NIV in consecutive subjects with de novo acute respiratory failure. The primary outcomes were NIV failure rates and 28-d mortality. The secondary outcomes were asynchrony index, NIV-related complications, and others.RESULTS: We enrolled 100 subjects (50 subjects each for NAVA and PSV, 60% male) with a mean ± SD age of 56.7 ± 12 y. There was no difference in NIV failure rates (30% vs 32%, P = .83) and 28-d mortality rates (18% vs 34%, P = .07) between the NAVA and PSV arms, respectively. The median asynchrony index was significantly lower with NAVA (6.7 vs 44.8, P < .001). The use of NAVA significantly reduced NIV-related complications (32% vs 58%, P = .01). In a post hoc analysis, the use of NAVA significantly reduced the 28-d mortality in subjects with COPD exacerbation.CONCLUSIONS: The use of NAVA during NIV did not improve NIV failure rate or 28-d mortality in subjects with acute respiratory failure. However, patient–ventilator asynchrony and NIV-related complications were reduced with NAVA.