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Nava ventilation

Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava
Rehabilitation is an integral component of care for patients affected by either acute or chronic pulmonary diseases. The key elements of rehabilitation treatment for critical respiratory patients are as follows: weaning from mechanical ventilation, respiratory therapy, physical reconditioning, and occupational therapy. It should be noted that patients affected by pulmonary diseases are prone to hospital re-admission due to frequent exacerbations, especially in cases with more severe stages of chronic obstructive pulmonary disease...
September 22, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Keren Armoni Domany, Md Monir Hossain, Leonardo Nava-Guerra, Michael C Khoo, Keith McConnell, John L Carroll, Yuanfang Xu, Mark DiFrancesco, Raouf S Amin
Rationale The contribution of ventilatory control to the pathogenesis of obstructive sleep apnea (OSA) in preterm born children is unknown. Objectives To characterize phenotypes of ventilatory control that are associated with the presence of OSA in preterm born children during early childhood. Methods Preterm and term born children without comorbid conditions were enrolled. They were categorized into OSA group and non-OSA group based on polysomnography. Measurements Loop gain, controller gain and plant gain, reflecting ventilatory instability, chemoreceptor sensitivity and blood gas response to a change in ventilation, respectively, were estimated from spontaneous sighs identified during polysomnography...
January 11, 2018: American Journal of Respiratory and Critical Care Medicine
Vijay Hadda, Tajamul Hussain Shah, Karan Madan, Anant Mohan, Gopi C Khilnani, Randeep Guleria
Patient-ventilator asynchrony is common with noninvasive ventilation (NIV) used for management of acute exacerbation of chronic obstructive pulmonary disease (COPD). Neurally adjusted ventilator assist (NAVA) is a mode of ventilatory support which can minimize the patient-ventilator asynchrony. Delivering NIV with NAVA (NIV-NAVA) during acute exacerbation of COPD seems a logical approach and may be useful in reducing patient-ventilator asynchrony. However, there are no published reports which describe the use of NIV-NAVA for management of acute exacerbation of COPD...
January 2018: Lung India: Official Organ of Indian Chest Society
Rui Chen, Angela Aherrera, Chineye Isichei, Pablo Olmedo, Stephanie Jarmul, Joanna E Cohen, Ana Navas-Acien, Ana M Rule
E-cigarette (vaping) conventions are public events promoting electronic cigarettes, in which indoor use of e-cigarettes is allowed. The large concentration of people using e-cigarettes and poor air ventilation can result in indoor air pollution. In order to estimate this worst-case exposure to e-cigarettes, we evaluated indoor air quality in a vaping convention in Maryland (MD), USA. Real-time concentrations of particulate matter (PM10 ) and real-time total volatile organic compounds (TVOCs), CO2 and NO2 concentrations were measured...
December 29, 2017: Journal of Exposure Science & Environmental Epidemiology
Arata Oda, Liisa Lehtonen, Hanna Soukka
Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that triggers, cycles and delivers assistance in response to the electrical activity of the diaphragm (EAdi). The EAdi signal is measured with an EAdi catheter (Maquet, Solna, Sweden) that includes nine miniaturised electrodes and is positioned in the oesophagus at the level of the diaphragm. NAVA has been shown to decrease peak inspiratory pressures, which are potentially harmful for immature lungs (1,2) and, therefore, it may decrease ventilator induced lung injury, particularly pulmonary hypoplasia in congenital diaphragmatic hernia (CDH)...
December 16, 2017: Acta Paediatrica
Benjamin Crulli, Mariam Khebir, Baruch Toledano, Suzanne Vobecky, Nancy Poirier, Guillaume Emeriaud
BACKGROUND: After pediatric cardiac surgery, ventilation with high airway pressures can be detrimental to right ventricular function and pulmonary blood flow. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interactions, helping maintain spontaneous ventilation. This study reports our experience with the use of NAVA in children after a cardiac surgery. We hypothesize that using NAVA in this population is feasible and allows for lower ventilation pressures. METHODS: We retrospectively studied all children ventilated with NAVA (invasively or noninvasively) after undergoing cardiac surgery between January 2013 and May 2015 in our pediatric intensive care unit...
February 2018: Respiratory Care
Federico Longhini, Davide Colombo, Lara Pisani, Francesco Idone, Pan Chun, Jonne Doorduin, Liu Ling, Moreno Alemani, Andrea Bruni, Jin Zhaochen, Yu Tao, Weihua Lu, Eugenio Garofalo, Luca Carenzo, Salvatore Maurizio Maggiore, Haibo Qiu, Leo Heunks, Massimo Antonelli, Stefano Nava, Paolo Navalesi
The objective of this study was to assess ability to identify asynchronies during noninvasive ventilation (NIV) through ventilator waveforms according to experience and interface, and to ascertain the influence of breathing pattern and respiratory drive on sensitivity and prevalence of asynchronies. 35 expert and 35 nonexpert physicians evaluated 40 5-min NIV reports displaying flow-time and airway pressure-time tracings; identified asynchronies were compared with those ascertained by three examiners who evaluated the same reports displaying, additionally, tracings of diaphragm electrical activity...
October 2017: ERJ Open Research
Gennaro De Pascale, Otavio T Ranzani, Saad Nseir, Jean Chastre, Tobias Welte, Massimo Antonelli, Paolo Navalesi, Eugenio Garofalo, Andrea Bruni, Luis Miguel Coelho, Szymon Skoczynski, Federico Longhini, Fabio Silvio Taccone, David Grimaldi, Helmut J F Salzer, Christoph Lange, Filipe Froes, Antoni Artigas, Emili Díaz, Jordi Vallés, Alejandro Rodríguez, Mauro Panigada, Vittoria Comellini, Luca Fasano, Paolo M Soave, Giorgia Spinazzola, Charles-Edouard Luyt, Francisco Alvarez-Lerma, Judith Marin, Joan Ramon Masclans, Davide Chiumello, Angelo Pezzi, Marcus Schultz, Hafiz Mohamed, Menno Van Der Eerden, Roger A S Hoek, D A M P J Gommers, Marta Di Pasquale, Rok Civljak, Marko Kutleša, Matteo Bassetti, George Dimopoulos, Stefano Nava, Fernando Rios, Fernando G Zampieri, Pedro Povoa, Lieuwe D Bos, Stefano Aliberti, Antoni Torres, Ignacio Martín-Loeches
The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI...
October 2017: ERJ Open Research
Juliana C Ferreira, Fabia Diniz-Silva, Henrique T Moriya, Adriano M Alencar, Marcelo B P Amato, Carlos R R Carvalho
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs...
November 7, 2017: BMC Pulmonary Medicine
Thomas E Rossor, Katie A Hunt, Sandeep Shetty, Anne Greenough
BACKGROUND: Effective synchronisation of infant respiratory effort with mechanical ventilation may allow adequate gas exchange to occur at lower peak airway pressures, potentially reducing barotrauma and volutrauma and development of air leaks and bronchopulmonary dysplasia. During neurally adjusted ventilatory assist ventilation (NAVA), respiratory support is initiated upon detection of an electrical signal from the diaphragm muscle, and pressure is provided in proportion to and synchronous with electrical activity of the diaphragm (EADi)...
October 27, 2017: Cochrane Database of Systematic Reviews
J L Rosterman, E K Pallotto, W E Truog, H Escobar, K A Meinert, A Holmes, H Dai, W M Manimtim
OBJECTIVE: Examine respiratory severity scores (RSS) (mean airway pressure × fraction of inspired oxygen) and resting energy expenditure (REE) on neurally adjusted ventilatory assist (NAVA) compared with synchronized intermittent mandatory ventilation with pressure controlled and supported breath (SIMV (PC)PS). STUDY DESIGN: A randomized, crossover trial in a level IV neonatal intensive care unit. Twenty-four patients were ventilated with NAVA or SIMV (PC) PS for 12 h and then crossed over to the alternative mode for 12 h...
October 26, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
Daniel Garcia-Castellote, Abel Torres, Luis Estrada, Leonardo Sarlabous, Raimon Jane
Measuring diaphragmatic electromyography (EMGdi) provides an indirect quantification of neural respiratory drive and allows the delimitation of diaphragm neural activation and deactivation during inspiration. EMGdi recordings have been incorporated in novel modes of assisted mechanical ventilation, such as neurally adjusted ventilatory assist (NAVA), to trigger and cycle-off the ventilator. The EMGdi signal improves the assistance delivered by more conventional ventilatory modes, in which the ventilator is synchronized with the patient employing a pneumatic triggering...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
José Colleti, Walter Koga, Werther Brunow de Carvalho
OBJECTIVE: To report a rare case of dorsal brainstem syndrome in an infant after hypoxic-ischemic episode due to severe sepsis and the use of neurally adjusted ventilatory assist (NAVA) to aid in diagnosis and in the removal of mechanical ventilation. CASE DESCRIPTION: A 2-month-old male infant, previously healthy, presented with severe sepsis that evolved to dorsal brainstem syndrome, which usually occurs after hypoxic-ischemic injury in neonates and infants, and is related to very specific magnetic resonance images...
September 21, 2017: Revista Paulista de Pediatria: Orgão Oficial da Sociedade de Pediatria de São Paulo
Bram Rochwerg, Laurent Brochard, Mark W Elliott, Dean Hess, Nicholas S Hill, Stefano Nava, Paolo Navalesi, Massimo Antonelli, Jan Brozek, Giorgio Conti, Miquel Ferrer, Kalpalatha Guntupalli, Samir Jaber, Sean Keenan, Jordi Mancebo, Sangeeta Mehta, Suhail Raoof
Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature.The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question...
August 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Federico Longhini, Chun Pan, Jianfeng Xie, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Yi Yang, Paolo Navalesi, Haibo Qiu
BACKGROUND: Noninvasive ventilation (NIV) is generally delivered using pneumatically-triggered and cycled-off pressure support (PSP) through a mask. Neurally adjusted ventilatory assist (NAVA) is the only ventilatory mode that uses a non-pneumatic signal, i.e., diaphragm electrical activity (EAdi), to trigger and drive ventilator assistance. A specific setting to generate neurally controlled pressure support (PSN) was recently proposed for delivering NIV by helmet. We compared PSN with PSP and NAVA during NIV using a facial mask, with respect to patient comfort, gas exchange, and patient-ventilator interaction and synchrony...
July 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
Stefano Nava, Begum Ergan
No abstract text is available yet for this article.
July 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Roberta Costa, Paolo Navalesi, Gianmaria Cammarota, Federico Longhini, Giorgia Spinazzola, Flora Cipriani, Giuliano Ferrone, Olimpia Festa, Massimo Antonelli, Giorgio Conti
We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.05, 0.08, and 0.1μg·Kg(-1)·min(-)1) during both PSV and NAVA. We measured the patient's (Ti/Ttotneu) and ventilator (Ti/Ttotmec) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delaytrinsp) and expiratory (Delaytrexp) trigger delays and the Asynchrony Index (AI)...
July 1, 2017: Respiratory Physiology & Neurobiology
Evangelia Akoumianaki, Nicolas Dousse, Aissam Lyazidi, Jean-Claude Lefebvre, Severine Graf, Ricardo Luiz Cordioli, Nathalie Rey, Jean-Christophe Marie Richard, Laurent Brochard
BACKGROUND: Early exercise of critically ill patients may have beneficial effects on muscle strength, mass and systemic inflammation. During pressure support ventilation (PSV), a mismatch between demand and assist could increase work of breathing and limit exercise. A better exercise tolerance is possible with a proportional mode of ventilation (Proportional Assist Ventilation, PAV+ and Neurally Adjusted Ventilatory Assist, NAVA). We examined whether, in critically ill patients, PSV and proportional ventilation have different effects on respiratory muscles unloading and work efficiency during exercise...
December 2017: Annals of Intensive Care
Qin Sun, Ling Liu, Chun Pan, Zhanqi Zhao, Jingyuan Xu, Airan Liu, Haibo Qiu
BACKGROUND: Neurally adjusted ventilatory assist (NAVA) could improve patient-ventilator interaction; its effects on ventilation distribution and dead space are still unknown. The aim of this study was to evaluate the effects of varying levels of assist during NAVA and pressure support ventilation (PSV) on ventilation distribution and dead space in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Fifteen mechanically ventilated patients with AECOPD were included in the study...
June 2, 2017: Critical Care: the Official Journal of the Critical Care Forum
Shing-Yan Robert Lee
In the treatment of left-sided pulmonary interstitial emphysema (PIE) in a 23-week neonate, we used two ventilatory strategies: selective bronchial intubation from day 10 to 15 and neurally adjusted ventilatory assist (NAVA) from day 18 to 26. We compared the effects and adverse effects of these two strategies. On selective bronchial intubation, desaturation was frequent. Fentanyl infusion was required. There was an episode of carbon dioxide retention coupled with hypotension. On NAVA, the neonate was clinically stable without the requirement of sedation...
April 2017: American Journal of Perinatology Reports
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