title: Neurally adjusted ventilatory assist (NAVA) allows patient-ventilator synchrony during pediatric noninvasive ventilation: a crossover physiological study.
abstract: BACKGROUND
  The need for intubation after a noninvasive ventilation (NIV) failure is frequent in the pediatric intensive care unit (PICU). One reason is patient-ventilator asynchrony during NIV. Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation controlled by the patient's neural respiratory drive. The aim of this study was to assess the feasibility and tolerance of NIV-NAVA in children and to evaluate its impact on synchrony and respiratory effort.
  
  
  METHODS
  This prospective, physiologic, crossover study included 13 patients requiring NIV in the PICU of Sainte-Justine's Hospital from October 2011 to May 2013. Patients were successively ventilated in conventional NIV as prescribed by the physician in charge (30 minutes), in NIV-NAVA (60 minutes), and again in conventional NIV (30 minutes). Electrical activity of the diaphragm (EAdi) and airway pressure were simultaneously recorded to assess patient-ventilator synchrony.
  
  
  RESULTS
  NIV-NAVA was feasible and well tolerated in all patients. One patient asked to stop the study because of anxiety related to the leak-free facial mask. Inspiratory trigger dys-synchrony and cycling-off dys-synchrony were significantly shorter in NIV-NAVA versus initial and final conventional NIV periods (both P <0.05). Wasted efforts were also decreased in NIV-NAVA (all values expressed as median and interquartile values) (0 (0 to 0) versus 12% (4 to 20) and 6% (2 to 22), respectively; P <0.01). As a whole, total time spent in asynchrony was reduced to 8% (6 to 10) in NIV-NAVA, versus 27% (19 to 56) and 32% (21 to 38) in conventional NIV before and after NIV-NAVA, respectively (P =0.05).
  
  
  CONCLUSIONS
  NIV-NAVA is feasible and well tolerated in PICU patients and allows improved patient-ventilator synchronization. Larger controlled studies are warranted to evaluate the clinical impact of these findings.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02163382. Registered 9 June 2014.
authors.affiliation: Pediatric Intensive Care Unit, CHU Sainte-Justine, University of Montreal, 3175 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. lducharmecrevier@gmail.com.
authors.forename: Laurence
authors.initials: L
authors.lastname: Ducharme-Crevier
authors.affiliation: Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada. jennifer.beck@rogers.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beck
authors.affiliation: Pediatric Intensive Care Unit, CHU Sainte-Justine, University of Montreal, 3175 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. sandrine.essouri@bct.aphp.fr.|Pediatric Intensive Care Unit, CHU Kremlin Bicêtre, Université Paris Sud, Le Kremlin Bicêtre, France. sandrine.essouri@bct.aphp.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Essouri
authors.affiliation: Pediatric Intensive Care Unit, CHU Sainte-Justine, University of Montreal, 3175 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. philippe.jouvet@umontreal.ca.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jouvet
authors.affiliation: Pediatric Intensive Care Unit, CHU Sainte-Justine, University of Montreal, 3175 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. guillaume.emeriaud@umontreal.ca.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Emeriaud
mesh_terms: D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D003964:Diaphragm / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D059725:Interactive Ventilatory Support / Q000379:methods*; D008297:Male; D008397:Masks; D063087:Noninvasive Ventilation / Q000379:methods*; D011175:Positive-Pressure Respiration; D011446:Prospective Studies