title: Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: nested study.
abstract: OBJECTIVE
  Neurally adjusted ventilatory assist (NAVA) is a new ventilator modality with an innovative synchronization technique. Our aim is to verify if NAVA is feasible and safe in terms of physiological and clinical variables in infants recovering from severe acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  This is a pilot nested study to help future trial design.
  
  
  METHODS
  The study was performed in third-level academic pediatric intensive care units.
  
  
  METHODS
  Infants affected by severe ARDS requiring high-frequency ventilation and weaned with NAVA during 2010 were included. Controls (2:1 ratio) were ARDS infants weaned with pressure support ventilation (PSV) during 2008-2009 matched for age, gas exchange impairment, and weight.
  
  
  METHODS
  The main outcome measures were the physiological and ventilator parameters and the duration of ventilator support in PSV or NAVA.
  
  
  RESULTS
  Ten infants treated with NAVA and 20 with PSV were studied. Heart rate (P < .001) and mean arterial pressure (P < .001) increased less during NAVA than during PSV. Similarly, Pao2/Fio2 ratio decreased less in NAVA than in PSV (P < .001). Neurally adjusted ventilatory assist also resulted in lower Paco2 (P < .001) and peak pressure (P = .001), as well as higher minute ventilation (P = .013). COMFORT score (P = .004) and duration of support were lower in NAVA than in PSV (P = .011).
  
  
  CONCLUSIONS
  Neurally adjusted ventilatory assist is safe and suitable in infants recovering from severe ARDS. It could provide better results than PSV and is worth to be investigated in a multicenter randomized trial.
authors.affiliation: Paediatric Intensive Care Unit.
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.affiliation: Paediatric Intensive Care Unit; Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals, A.Beclere Medical Center, Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
authors.affiliation: VentiLab, Dept of Anaesthesiology and Intensive Care, Catholic University of the Sacred Heart, "A. Gemelli" University Hospital, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Costa
authors.affiliation: Paediatric Intensive Care Unit. Electronic address: a.pizza87@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pizza
authors.affiliation: Paediatric Intensive Care Unit.
authors.forename: Renata
authors.initials: R
authors.lastname: De Sanctis
authors.affiliation: Paediatric Intensive Care Unit.
authors.forename: Laura
authors.initials: L
authors.lastname: Marzano
authors.affiliation: Paediatric Intensive Care Unit.
authors.forename: Daniele
authors.initials: D
authors.lastname: Biasucci
authors.affiliation: Paediatric Intensive Care Unit.
authors.forename: Federico
authors.initials: F
authors.lastname: Visconti
authors.affiliation: Paediatric Intensive Care Unit; VentiLab, Dept of Anaesthesiology and Intensive Care, Catholic University of the Sacred Heart, "A. Gemelli" University Hospital, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
mesh_terms: D016022:Case-Control Studies; D005240:Feasibility Studies; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D015278:Intensive Care Units, Pediatric; D059725:Interactive Ventilatory Support / Q000009:adverse effects / Q000379:methods*; D010865:Pilot Projects; D045169:Severe Acute Respiratory Syndrome / Q000628:therapy*
chemical_list: D006993:Hypnotics and Sedatives
keywords: ARDS; Infants; Mechanical ventilation; NAVA; Pressure support; Weaning