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Abstract
BACKGROUND: Congenital diaphragmatic hernia is associated with a high risk of neonatal mortality and long-term morbidity due to lung hypoplasia, pulmonary hypertension, and prolonged exposure to positive-pressure ventilation. Ventilator-associated lung injury may be reduced by using approaches that facilitate the transition from invasive ventilation to noninvasive ventilation (NIV), such as with neurally-adjusted ventilatory assist (NAVA). We reported our use of NAVA in neonatal patients with congenital diaphragmatic hernia during the transition from invasive ventilation to NIV.
METHODS: A retrospective analysis of neonatal subjects with congenital diaphragmatic hernia admitted to a tertiary care children's hospital between December 2015 and May 2018 was conducted. Subject data and factors that affected the use of NAVA were analyzed.
RESULTS: Ten neonatal subjects with congenital diaphragmatic hernia were placed on NAVA, and 6 were successfully transitioned, after surgery, from pressure control synchronized intermittent mandatory ventilation to invasive ventilation with NAVA and then to NIV with NAVA without the need for re-intubation. The transition from pressure control synchronized intermittent mandatory ventilation to invasive ventilation with NAVA resulted in a decrease in peak inspiratory pressure, mean airway pressure, and 
. Barriers to the use of NAVA included symptomatic pleural effusion or chylothorax and pulmonary sequestration.
CONCLUSIONS: Both invasive ventilation with NAVA and NIV with NAVA were used successfully in subjects with congenital diaphragmatic hernia during the transition from invasive ventilation to NIV. The transition to NAVA was associated with a decrease in peak inspiratory pressure, mean airway pressure, and the need for supplemental oxygen. A prospective trial is needed to determine the short- and long-term impacts of this mode of ventilation in neonates with congenital diaphragmatic hernia.
- Neurally adjusted ventilatory assist
- NAVA
- NIV-NAVA
- congenital diaphragmatic hernia
- ventilation
- ventilator-associated lung injury
Footnotes
- Correspondence: David J McCulley MD, Division of Neonatology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, 408 McConnell Hall, 1010 Mound Street, Madison, WI 52726. E-mail: dmcculley{at}wisc.edu
Drs Meinen and McCulley presented a version of this paper at the Pediatric Critical Care Regional Conference, held May 23, 2018, in Madison, Wisconsin, and at the Midwest Society of Pediatric Research meeting, held October 2, 2018, in Royal Oak, Michigan.
The authors have disclosed no conflicts of interest.
- Copyright © 2021 by Daedalus Enterprises
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