title: Comparison of neurally-adjusted ventilator assist in infants before and after extubation.
abstract: BACKGROUND
  To compare invasive (iNAVA) and non-invasive (nivNAVA) neurally adjusted ventilatory assist in infants, respect to gas exchange, breathing pattern, respiratory drive, infant-ventilator interaction and synchrony, vital parameters and required sedation.
  
  
  METHODS
  Ten consecutive intubated term infants admitted for respiratory failure of different etiology underwent to 2-hour not-randomized trials of iNAVA and, after extubation, nivNAVA, the latter with unchanged ventilator settings and with air-leaks compensating software. Arterialized capillary blood was sampled at the end of each trial. We computed: 1) the minimum (EAdimin) and peak (EAdipeak) values of the diaphragm electrical activity; 2) ventilator (RRmec) and own patients' (RRneu) respiratory rates; 3) inspiratory (delayTR-insp) and expiratory trigger delays (delayTR-exp) and the time of synchrony between patient's effort and ventilator assistance (Timesynch/Tineu); 4) the asynchrony index. Vital parameters and required sedation were also recorded.
  
  
  RESULTS
  iNAVA and nivNAVA did not differ between in terms of gas exchange (pH (7.35 [7.31-7.41] vs. 7.36 [7.30-7.40], P=0.745), PcCO2 (38.4 [34.8-42.6] vs. 36.9 [33.9-41.6] mmHg, P=0.469) and PcO2/FiO2 (211 [168-323] vs. 214 [189-282], P=0.195), respectively). EAdimin, EAdipeak, RRmec and RRneu were similar before and after extubation. Both modes confirmed an optimal infant-ventilator interaction (i.e. delayTR-insp, delayTR-exp and Timesynch/Tineu), irrespective of the interface, and no patients showed clinical relevant asynchronies. A low requirement of sedation with fentanyl was recorded during both trials, without differences between.
  
  
  CONCLUSIONS
  We found iNAVA and nivNAVA to be characterized by similar gas exchange, breathing pattern, respiratory drive, infant-ventilator interaction and synchrony, vital parameters and required sedation.
authors.affiliation: Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Longhini
authors.affiliation: Unit of Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Scarlino
authors.affiliation: Unit of Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Gallina
authors.affiliation: Unit of Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy.|Division of Pediatrics, Department of Health Sciences, A. Avogadro University Eastern Piedmont, Novara, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Monzani
authors.affiliation: Unit of Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: DE Franco
authors.affiliation: Unit of Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Erica C
authors.initials: EC
authors.lastname: Grassino
authors.affiliation: Division of Pediatrics, Department of Health Sciences, A. Avogadro University Eastern Piedmont, Novara, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Bona
authors.affiliation: Unit of Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy - federica.ferrero@maggioreosp.novara.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Ferrero
mesh_terms: D060666:Airway Extubation; D018592:Cross-Over Studies; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007231:Infant, Newborn; D059725:Interactive Ventilatory Support / Q000379:methods*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012119:Respiration; D015656:Respiratory Mechanics / Q000502:physiology*
chemical_list: D006993:Hypnotics and Sedatives; D005283:Fentanyl