Neurally adjusted ventilatory assist mode used in congenital diaphragmatic hernia.
A term baby with congenital diaphragmatic hernia (CDH) underwent surgical repair on the second day of life. Postoperatively; the oxygenation index increased to 85 despite high pressure ventilation with HFOV (high frequency oscillator ventilation) and inhaled nitric oxide therapy. Oxygenation index above 70 carries a mortality rate of 94% and merits starting extracorporeal membrane oxygenation (not available in the UAE). A trial of neurally adjusted ventilatory assist (NAVA) on the 10th postoperative day was followed by a reduction of oxygenation index to 15 and marked improvement of the clinical parameters. The EAdi (electrical activity of diaphragm) signal was relatively weak (± 5 μvolt) requiring augmentation with a high NAVA level (3 - 3.5). The patient was successfully extubated after 3 weeks.
Department of Paediatrics, Tawam Hospital in Association with Johns Hopkins Medicine, Al Ain, Abu Dhabi, United Arab Emirates. rehman_naveed@hotmail.com
Naveed-ur-Rehman
NU
Durrani
Fares
F
Chedid
Aiman
A
Rahmani
D016638:Critical Illness / Q000628:therapy; D006548:Hernia, Diaphragmatic / Q000601:surgery / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D059725:Interactive Ventilatory Support / Q000379:methods; D010100:Oxygen / Q000097:blood; D015300:Ventilator Weaning
D010100:Oxygen