NAVA vs. Pressure Support in Pediatric Patients

Pressure Support Ventilation can be  associated with 8 types of patient ventilator asynchronies. 

Overview

The researchers sought to determine if neurally adjusted ventilatory assist (NAVA) enhances asynchrony, ventilatory drive, breath-to-breath variability and COMFORT score when compared to pressure support (PS).  Twelve pediatric patients with asynchrony (auto-triggering, double triggering or non-triggered breaths) were enrolled in a non-randomized short-term cross-over trial.  Four sequential 10-min periods of data were recorded after 20 min of ventilatory stabilization (wash-out) at pre-determined settings.

Results

The median asynchrony index was notably lower during NAVA than during 2-PS(opt) and 4-PS(opt). In NAVA mode, the NAVA trigger accounted for approximately 66% of triggered breaths. The median trigger delay with respect to neural inspiratory time was considerably lower during NAVA than during 2-PS(opt) and 4-PS(opt). The median electrical activity of the diaphragm (EAdi) change during trigger delay normalized to maximum inspiratory. EAdi difference was notably lower during NAVA than during 2-PS(opt) and 4-PS(opt).  Additionally, NAVA produced a significantly higher coefficient of variation of tidal volume than 2-PS(opt) and 4-PS(opt). The median comfort score during NAVA was lower than that during 2-PS(opt) and 4-PS(opt).

Conclusion

This research shows that NAVA results in improved synchrony, reduced ventilatory drive, increased breath-to-breath mechanical variability and improved patient comfort compared to optimized PS.

Reference

De le Olivia, P., Schuffelmann, C., Gomez-Zamora, A., & Kacmarek, R. M., (2012). Asynchrony, neural drive, ventilatory variability and COMFORT: NAVA versus pressure support in pediatric patients. A non-randomized cross-over trial. Intensive Care Medicine, 38(5), 838-846.

Capture the Flag: Vent Graphics Contest

http://www.youtube.com/user/devinsupertramp

I have many people ask how I create and capture videos of ventilator waveforms. In this post I will describe  my techniques and introduce a ventilator screen capture contest for my new book Ventilator Graphics: Identifying Patient Ventilator Asynchrony & Optimizing Settings (2nd Ed).

Here are the contest prizes:

1. iTunes gift card ($50), free copy of the new book ($9.99), your screen shot will be used in the new book.
2. iTunes gift card ($25) free copy of the new book ($9.99), your screen shot will be used in the new book.
3. iTunes gift card ($10) free copy of the new book ($9.99), your screen shot will be used in the new book.

Why Aren't Your Patients Weaning? Don't Blame Nursing

http://respiratorytherapycave.blogspot.com/

The successful weaning and extubation of ventilated patients decreases hospital length of stay and reduces morbidity and mortality. One tool utilized to facilitate this process is “wean predictors” incorporated into RCP driven protocols to determine whether a patient may advance to a spontaneous breathing trial (SBT).

In a previous post [1] I mentioned that the level of sedation was the foremost reason why patients did not progress to a spontaneous breathing trial with a prevalence of 48%. 

This is concerning since it is a standard of care to provide ventilator patients with a daily "sedation vacation" or a interruption or decrease in sedation to assess neurological status and wean readiness.

This poses many questions: