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Abstract
Background: Non-invasive ventilation is increasingly used as a respiratory support therapy. Neurally adjusted ventilatory assist (NAVA) is a novel mode of mechanical ventilation, which could improve patient-ventilator interaction.
Objective: Implement a meta-analysis to compare patient-ventilator interaction and clinical outcomes between NAVA and pressure support ventilation (PSV) in adult patients during NIV.
Methods: The Pubmed, Cochrane Library, Web of science, OpenGrey and Embase databases were searched for appropriate clinical trials comparing NIV-NAVA with NIV-PSV for adult patients. Comparisons of asynchrony index (AI), types of asynchrony and clinical outcomes were pooled.
Results: 15 studies were included involving 615 subjects. AI was significantly lower in NAVA than PSV group (MD -14.70, 95% CI: -23.20 to -6.19, P < 0.001). Subgroup analysis grouped by exacerbation of chronic obstructive pulmonary diseases (COPD) or non-COPD showed that the AI of NAVA was lower than PSV in COPD exacerbation (MD -14.56, 95% CI: -21.04 to -8.09, P < 0.001) and non-COPD (MD -3.02, 95% CI: -4.44 to -1.61, P < 0.001). Severe asynchrony was significantly lower in NAVA than in PSV (OR 0.06, 95% CI: 0.03 to 0.11, P < 0.001). Inspiratory trigger delay in NAVA was significantly lower than PSV (MD -129.60, 95% CI: -148.43 to -110.78, P < 0.001). NAVA had longer ICU duration than PSV (MD 1.22, 95% CI: 0.44 to 2.00, P = 0.002). Level of discomfort was significantly higher in NAVA group than PSV group (MD 0.62, 95% CI: 0.02 to 1.21, P = 0.04).
Conclusion: NAVA has more advantages in ventilator-patient interaction than PSV in NIV. Further high quality research is needed in order to estimate effects on clinical outcomes.
Footnotes
- Corresponding author: Cao Liuzhao, Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, #98 Nangtong Xi Road, Yangzhou City 225001, Jiangsu, People's Republic of China. E-mail: lzcao1992{at}163.com
- Received December 12, 2021.
- Accepted February 10, 2022.
- Copyright © 2022 by Daedalus Enterprises
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