Neurally adjusted ventilatory assist in preterm neonates with acute respiratory failure.
BACKGROUND
Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that has been demonstrated to improve infant-ventilator interaction, compared to the conventional modes in retrospective and short-term studies.


OBJECTIVE
To prospectively evaluate the physiologic effects of NAVA in comparison with pressure-regulated volume control (PRVC) in two nonrandomized 12-hour periods.


METHODS
We studied 14 consecutive intubated preterm neonates receiving mechanical ventilation for acute respiratory failure. Peak airway pressure (Pawpeak), diaphragm electrical activity (EAdi), tidal volume (VT), mechanical (RRmec) and neural (RRneu) respiratory rates, neural apneas, and the capillary arterialized blood gases were measured. The RRmec-to-RRneu ratio (MNR) and the asynchrony index were also calculated. The amount of fentanyl administered was recorded.


RESULTS
Pawpeak and VT were greater in PRVC (p < 0.01). Blood gases and RRmec were not different between modes, while RRneu and the EAdi swings were greater in NAVA (p = 0.02 and p < 0.001, respectively). MNR and the asynchrony index were remarkably lower in NAVA than in PRVC (p = 0.03 and p < 0.001, respectively). 1,841 neural apneas were observed during PRVC, with none in NAVA. Less fentanyl was administered during NAVA, as opposed to PRVC (p < 0.01).


CONCLUSIONS
In acutely ill preterm neonates, NAVA can be safely and efficiently applied for 12 consecutive hours. Compared to PRVC, NAVA is well tolerated with fewer sedatives.
Department of Translational Medicine, Eastern Piedmont University 'A. Avogadro', Novara, Italy.
Federico
F
Longhini
Federica
F
Ferrero
Daniele
D
De Luca
Gianluca
G
Cosi
Moreno
M
Alemani
Davide
D
Colombo
Gianmaria
G
Cammarota
Paola
P
Berni
Giorgio
G
Conti
Gianni
G
Bona
Francesco
F
Della Corte
Paolo
P
Navalesi
D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001784:Blood Gas Analysis / Q000379:methods; D057186:Comparative Effectiveness Research; D018592:Cross-Over Studies; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D059725:Interactive Ventilatory Support / Q000009:adverse effects / Q000379:methods; D008297:Male; D008991:Monitoring, Physiologic; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D005283:Fentanyl