title: Prospective crossover comparison between NAVA and pressure control ventilation in premature neonates less than 1500 grams.
abstract: OBJECTIVE
  Neurally adjusted ventilatory assist (NAVA) synchronizes spontaneous respiratory effort with mechanical ventilation. Electrodes detect the electrical activity of the diaphragm (Edi) and transmit this information to the ventilator, allowing the patient to determine their own respiratory rate (RR), peak pressures, and inspiratory and expiratory times in synchrony with the ventilator. The objective of this study was to evaluate if premature neonates ventilate as effectively on NAVA as compared to pressure control ventilation (PCV).
  
  
  METHODS
  Five ventilated neonates were enrolled (gestational age 25-29 weeks). Each neonate was ventilated on NAVA for 4 h, then switched to PCV for another 4 h. The cycle was repeated three times. Ventilatory parameters were averaged every 30 min to collect eight time points for each ventilatory mode. Data were analyzed using the mixed effects model procedure, utilizing the least-squares means (P<0.05).
  
  
  RESULTS
  When compared to PCV, neonates ventilated with NAVA had lower peak inspiratory pressures (PIP), fraction of inspired oxygen (FiO2), transcutaneous PCO2 Edi peak and RR. There was an increase in expiratory tidal volume (TV), compliance and Edi minimum. Despite lower PIP and RR, partial pressure of CO2 (PCO2) was lower when ventilated on NAVA. There was no difference in mean airway pressure.
  
  
  CONCLUSIONS
  Premature neonates ventilated with NAVA required less PIP, FiO2 and RR to achieve lower PCO2 and better compliance compared with PCV.
authors.affiliation: Department of Neonatology, Toledo Children Hospital, Toledo, OH 43606, USA. Howardstein@bex.net
authors.forename: H
authors.initials: H
authors.lastname: Stein
authors.forename: H
authors.initials: H
authors.lastname: Alosh
authors.forename: P
authors.initials: P
authors.lastname: Ethington
authors.forename: D B
authors.initials: DB
authors.lastname: White
mesh_terms: D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D059725:Interactive Ventilatory Support / Q000295:instrumentation / Q000379:methods*; D008297:Male; D009820:Ohio; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology
chemical_list: D010100:Oxygen