title: NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand.
abstract: Neurally adjusted ventilatory assist (NAVA) is a ventilation assist mode that delivers pressure in proportionality to electrical activity of the diaphragm (Eadi). Compared to pressure support ventilation (PS), it improves patient-ventilator synchrony and should allow a better expression of patient's intrinsic respiratory variability. We hypothesize that NAVA provides better matching in ventilator tidal volume (Vt) to patients inspiratory demand. 22 patients with acute respiratory failure, ventilated with PS were included in the study. A comparative study was carried out between PS and NAVA, with NAVA gain ensuring the same peak airway pressure as PS. Robust coefficients of variation (CVR) for Eadi and Vt were compared for each mode. The integral of Eadi (ʃEadi) was used to represent patient's inspiratory demand. To evaluate tidal volume and patient's demand matching, Range90 = 5-95 % range of the Vt/ʃEadi ratio was calculated, to normalize and compare differences in demand within and between patients and modes. In this study, peak Eadi and ʃEadi are correlated with median correlation of coefficients, R > 0.95. Median ʃEadi, Vt, neural inspiratory time (Ti_ ( Neural )), inspiratory time (Ti) and peak inspiratory pressure (PIP) were similar in PS and NAVA. However, it was found that individual patients have higher or smaller ʃEadi, Vt, Ti_ ( Neural ), Ti and PIP. CVR analysis showed greater Vt variability for NAVA (p < 0.005). Range90 was lower for NAVA than PS for 21 of 22 patients. NAVA provided better matching of Vt to ʃEadi for 21 of 22 patients, and provided greater variability Vt. These results were achieved regardless of differences in ventilatory demand (Eadi) between patients and modes.
authors.affiliation: Cardiovascular Research Center, University of Liege, Liege, Belgium. tout.petit.cochon@gmail.com
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Moorhead
authors.forename: Lise
authors.initials: L
authors.lastname: Piquilloud
authors.forename: Bernard
authors.initials: B
authors.lastname: Lambermont
authors.forename: Jean
authors.initials: J
authors.lastname: Roeseler
authors.forename: Yeong Shiong
authors.initials: YS
authors.lastname: Chiew
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Revelly
authors.forename: Emilie
authors.initials: E
authors.lastname: Bialais
authors.forename: Didier
authors.initials: D
authors.lastname: Tassaux
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
authors.forename: Philippe
authors.initials: P
authors.lastname: Jolliet
authors.forename: Thierry
authors.initials: T
authors.lastname: Sottiaux
authors.forename: Thomas
authors.initials: T
authors.lastname: Desaive
mesh_terms: D000368:Aged; D003964:Diaphragm / Q000502:physiology*; D004576:Electromyography; D006801:Humans; D001239:Inhalation / Q000502:physiology; D059725:Interactive Ventilatory Support / Q000379:methods*; D008875:Middle Aged; D008954:Models, Biological; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome