title: Physiological comparison of breathing patterns with neurally adjusted ventilatory assist (NAVA) and pressure-support ventilation to improve NAVA settings.
abstract: Neurally adjusted ventilator assist (NAVA) assists spontaneous breathing in proportion to diaphragmatic electrical activity (EAdi). Here, we evaluate the effects of various levels of NAVA and PSV on the breathing pattern and, thereby, on [Formula: see text] homeostasis in 10 healthy volunteers. For each ventilation mode, four levels of support (delivered pressure 0 i.e. baseline, 5, 8, and 10cmH2O) were tested in random order. EAdi, flow, and airway pressure were recorded. Optoelectronic plethysmography was used to study lung volume distribution. During both PSV and NAVA, EAdi decreased with the level of assistance (P<0.01). Tidal volume (VT) increased and [Formula: see text] decreased with increased levels of PSV (P=0.044 and P=0.0004; respectively) while no change was observed with NAVA. Subject-ventilator synchronization was better with NAVA than with PSV. NAVA and PSV similarly decreased the abdominal contribution to VT. No airflow profile similarities were observed between baseline and mechanical ventilation. Diaphragmatic activity can decrease during NAVA without any change in VT and [Formula: see text] . This suggests that NAVA adjustment cannot be based solely on VT and [Formula: see text] criteria. Registered by Frédéric Lofaso and Nicolas Terzi on ClinicalTrials.gov, #NCT01614873.
authors: Centre d'Investigation Clinique - Innovations Technologiques, Services de Physiologie - Explorations Fonctionnelles, Hôpital Raymond Poincaré, AP-HP, France; E.A. 4497, Université de Versailles-Saint Quentin en Yvelines, 92380 Garches, France.
authors: Henri
authors: H
authors: Meric
authors: UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble F-38041, France.
authors: Pascale
authors: P
authors: Calabrese
authors: Centre d'Investigation Clinique - Innovations Technologiques, Services de Physiologie - Explorations Fonctionnelles, Hôpital Raymond Poincaré, AP-HP, France; E.A. 4497, Université de Versailles-Saint Quentin en Yvelines, 92380 Garches, France.
authors: Didier
authors: D
authors: Pradon
authors: Centre d'Investigation Clinique - Innovations Technologiques, Services de Physiologie - Explorations Fonctionnelles, Hôpital Raymond Poincaré, AP-HP, France; E.A. 4497, Université de Versailles-Saint Quentin en Yvelines, 92380 Garches, France.
authors: Michèle
authors: M
authors: Lejaille
authors: Centre d'Investigation Clinique - Innovations Technologiques, Services de Physiologie - Explorations Fonctionnelles, Hôpital Raymond Poincaré, AP-HP, France; E.A. 4497, Université de Versailles-Saint Quentin en Yvelines, 92380 Garches, France; Inserm U 955, 94000 Créteil, France.
authors: Frédéric
authors: F
authors: Lofaso
authors: Normandie University, France; UNICAEN, COMETE, 14032 Caen, France; Inserm, U 1075 COMETE, 14032 Caen, France; CHU de Caen, Department of Intensive Care, 14000 Caen, France. Electronic address: terzi-n@chu-caen.fr.
authors: Nicolas
authors: N
authors: Terzi
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000502:physiology; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology; D059725:Interactive Ventilatory Support; D008168:Lung / Q000502:physiology; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D011312:Pressure; D012119:Respiration; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*; D056152:Respiratory Rate / Q000502:physiology; D055815:Young Adult
keywords: Breathing control; Mechanical ventilation; Neurally adjusted ventilator assist; Optoelectronic plethysmography