title: Neurally adjusted ventilatory assist (NAVA) in preterm newborn infants with respiratory distress syndrome-a randomized controlled trial.
abstract: Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator synchrony during invasive ventilation and leads to lower peak inspiratory pressures (PIP) and oxygen requirements. The aim of this trial was to compare NAVA with current standard ventilation in preterm infants in terms of the duration of invasive ventilation. Sixty infants born between 28 + 0 and 36 + 6 weeks of gestation and requiring invasive ventilation due to neonatal respiratory distress syndrome (RDS) were randomized to conventional ventilation or NAVA. The median durations of invasive ventilation were 34.7 h (quartiles 22.8-67.9 h) and 25.8 h (15.6-52.1 h) in the NAVA and control groups, respectively (P = 0.21). Lower PIPs were achieved with NAVA (P = 0.02), and the rapid reduction in PIP after changing the ventilation mode to NAVA made following the predetermined extubation criteria challenging. The other ventilatory and vital parameters did not differ between the groups. Frequent apneas and persistent pulmonary hypertension were conditions that limited the use of NAVA in 17 % of the patients randomized to the NAVA group. Similar cumulative doses of opiates were used in both groups (P = 0.71).
  
  
  CONCLUSIONS
  NAVA was a safe and feasible ventilation mode for the majority of preterm infants suffering from RDS, but the traditional extubation criteria were not clinically applicable during NAVA.
  
  
  BACKGROUND
  • NAVA improves patient-ventilator synchrony during invasive ventilation. • Lower airway pressures and oxygen requirements are achieved with NAVA during invasive ventilation in preterm infants by comparison with conventional ventilation. What is new: • Infants suffering from PPHN did not tolerate NAVA in the acute phase of their illness. • The traditional extubation criteria relying on inspiratory pressures and spontaneous breathing efforts were not clinically applicable during NAVA.
authors: PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland. merja.kallio@oulu.fi.|Department of Children and Adolescents, Oulu University Hospital, BOX 5000, FIN-90014, Oulu, Finland. merja.kallio@oulu.fi.
authors: Merja
authors: http://orcid.org/0000-0003-0799-344X
authors: M
authors: Kallio
authors: PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Children and Adolescents, Oulu University Hospital, BOX 5000, FIN-90014, Oulu, Finland.
authors: Ulla
authors: U
authors: Koskela
authors: PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Children and Adolescents, Oulu University Hospital, BOX 5000, FIN-90014, Oulu, Finland.
authors: Outi
authors: O
authors: Peltoniemi
authors: PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors: Tero
authors: T
authors: Kontiokari
authors: PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Children and Adolescents, Oulu University Hospital, BOX 5000, FIN-90014, Oulu, Finland.
authors: Tytti
authors: T
authors: Pokka
authors: Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors: Maria
authors: M
authors: Suo-Palosaari
authors: PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Children and Adolescents, Oulu University Hospital, BOX 5000, FIN-90014, Oulu, Finland.
authors: Timo
authors: T
authors: Saarela
mesh_terms: D000208:Acute Disease; D060666:Airway Extubation / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal; D059725:Interactive Ventilatory Support / Q000295:instrumentation / Q000379:methods*; D016014:Linear Models; D008297:Male; D010100:Oxygen / Q000097:blood; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D010100:Oxygen
keywords: Edi signal; Invasive ventilation; NAVA; Neonate; Preterm infant; Respiratory distress