title: Feasibility and physiological effects of noninvasive neurally adjusted ventilatory assist in preterm infants.
abstract: BackgroundNoninvasive neurally adjusted ventilator assist (NIV-NAVA) was introduced to our clinical practice via a pilot and a randomized observational study to assess its safety, feasibility, and short-term physiological effects.MethodsThe pilot protocol applied NIV-NAVA to 11 infants on nasal CPAP, high-flow nasal cannula, or nasal intermittent mandatory ventilation (NIMV), in multiple 2- to 4-h periods of NIV-NAVA for comparison. This provided the necessary data to design a randomized, controlled observational crossover study in eight additional infants to compare the physiological effects of NIV-NAVA with NIMV during 2-h steady-state conditions. We recorded the peak inspiratory pressure (PIP), FiO2, Edi, oxygen saturations (histogram analysis), transcutaneous PCO2, and movement with an Acoustic Respiratory Movement Sensor.ResultsThe NAVA catheter was used for 81 patient days without complications. NIV-NAVA produced significant reductions (as a percentage of measurements on NIMV) in the following: PIP, 13%; FiO2, 13%; frequency of desaturations, 42%; length of desaturations, 32%; and phasic Edi, 19%. Infant movement and caretaker movement were reduced by 42% and 27%, respectively. Neural inspiratory time was increased by 39 ms on NIV-NAVA, possibly due to Head's paradoxical reflex.ConclusionNIV-NAVA was a safe, alternative mode of noninvasive support that produced beneficial short-term physiological effects, especially compared with NIMV.
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, San Diego, California.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Gibu
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, San Diego, California.
authors.forename: Phillip Y
authors.initials: PY
authors.lastname: Cheng
authors.affiliation: BioData Innovation Systems, Inc., Carlsbad, California.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Ward
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, San Diego, California.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Castro
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of California, San Diego, California.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Heldt
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D057785:Catheters; D045422:Continuous Positive Airway Pressure; D018592:Cross-Over Studies; D005240:Feasibility Studies; D005865:Gestational Age; D007234:Infant, Premature; D059725:Interactive Ventilatory Support / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008168:Lung / Q000503:physiopathology; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D010865:Pilot Projects; D012119:Respiration; D013997:Time Factors; D016896:Treatment Outcome