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Neurally adjusted ventilator assist

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https://www.readbyqxmd.com/read/30045094/standardized-unloading-of-respiratory-muscles-during-neurally-adjusted-ventilatory-assist-a-randomized-crossover-pilot-study
#1
Francesca Campoccia Jalde, Fredrik Jalde, Mats K E B Wallin, Fernando Suarez-Sipmann, Peter J Radell, David Nelson, Staffan Eksborg, Peter V Sackey
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Currently, there is no standardized method to set the support level in neurally adjusted ventilatory assist (NAVA). The primary aim was to explore the feasibility of titrating NAVA to specific diaphragm unloading targets, based on the neuroventilatory efficiency (NVE) index. The secondary outcome was to investigate the effect of reduced diaphragm unloading on distribution of lung ventilation. METHODS: This is a randomized crossover study between pressure support and NAVA at different diaphragm unloading at a single neurointensive care unit...
July 25, 2018: Anesthesiology
https://www.readbyqxmd.com/read/30026086/glottic-patency-during-noninvasive-ventilation-in-patients-with-chronic-obstructive-pulmonary-disease
#2
Eline Oppersma, Jonne Doorduin, Petra J Gooskens, Lisanne H Roesthuis, Erik H F M van der Heijden, Johannes G van der Hoeven, Peter H Veltink, Leo M A Heunks
BACKGROUND: Non-invasive ventilation (NIV) provides ventilatory support for patients with respiratory failure. However, the glottis can act as a closing valve, limiting effectiveness of NIV. This study investigates the patency of the glottis during NIV in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). METHODS: Electrical activity of the diaphragm, flow, pressure and videolaryngoscopy were acquired. NIV was randomly applied in pressure support (PSV) and neurally adjusted ventilatory assist (NAVA) mode with two levels of support...
July 17, 2018: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/30020347/patient-ventilator-asynchrony
#3
Marcelo Alcantara Holanda, Renata Dos Santos Vasconcelos, Juliana Carvalho Ferreira, Bruno Valle Pinheiro
Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow...
July 16, 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/29988666/ventilator-auto-triggering-by-cardiac-electrical-activity-during-noninvasive-ventilation-with-neurally-adjusted-ventilatory-assist
#4
Yu Inata, Muneyuki Takeuchi
Neurally adjusted ventilatory assist (NAVA), by capturing the electrical activity of the diaphragm, improves patient-ventilator synchrony. It is, however, not completely immune from auto-triggering by cardiac electrical activity as illustrated in this case. Stringent observation of respiratory rate and vigilance for this phenomenon is warranted when using NAVA.
July 2018: Clinical Case Reports
https://www.readbyqxmd.com/read/29944776/neurally-adjusted-ventilatory-assist-in-extremely-low-birth-weight-infants
#5
Arata Oda, Yoshiya Kamei, Takehiko Hiroma, Tomohiko Nakamura
BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is expected to improve respiratory outcomes in preterm infants; however, it has not yet been evaluated. We investigated whether NAVA could improve respiratory outcomes and reduce sedation use in extremely low birth weight infants (ELBWIs). METHODS: A retrospective cohort study was conducted based on patient charts at Nagano Children's Hospital NICU, Japan. Infants who were born at less than 27-weeks gestation were included...
June 26, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/29910465/neural-breathing-patterns-in-preterm-newborns-supported-with-non-invasive-neurally-adjusted-ventilatory-assist
#6
Fermín García-Muñoz Rodrigo, Lourdes Urquía Martí, Gloria Galán Henríquez, Sonia Rivero Rodríguez, Alberto Hernández Gómez
OBJECTIVE: To characterize the neural breathing pattern in preterm infants supported with non-invasive neurally adjusted ventilatory assist (NIV-NAVA). STUDY DESIGN: Single-center prospective observational study. The electrical activity of the diaphragm (EAdi) was periodically recorded in 30-second series with the Edi catheter and the Servo-n software (Maquet, Solna, Sweden) in preterm infants supported with NIV-NAVA. The EAdiPeak , EAdiMin , EAdiTonic , EAdiPhasic , neural inspiratory, and expiratory times (nTi and nTe) and the neural respiratory rate (nRR) were calculated...
June 18, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29319038/noninvasive-ventilation-neurally-adjusted-ventilator-assist-for-management-of-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#7
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
https://www.readbyqxmd.com/read/29247545/neurally-adjusted-ventilatory-assist-can-be-used-to-wean-infants-with-congenital-diaphragmatic-hernias-off-respiratory-support
#8
Arata Oda, Liisa Lehtonen, Hanna Soukka
No abstract text is available yet for this article.
April 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29208756/neurally-adjusted-ventilatory-assist-after-pediatric-cardiac-surgery-clinical-experience-and-impact-on-ventilation-pressures
#9
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
https://www.readbyqxmd.com/read/29189671/neural-breathing-pattern-and-patient-ventilator-interaction-during-neurally-adjusted-ventilatory-assist-and-conventional-ventilation-in-newborns
#10
Pradeep V Mally, Jennifer Beck, Christer Sinderby, Martha Caprio, Sean M Bailey
OBJECTIVE: To compare neurally adjusted ventilatory assist and conventional ventilation on patient-ventilator interaction and neural breathing patterns, with a focus on central apnea in preterm infants. DESIGN: Prospective, observational cross-over study of intubated and ventilated newborns. Data were collected while infants were successively ventilated with three different ventilator conditions (30 min each period): 1) synchronized intermittent mandatory ventilation (SIMV) combined with pressure support at the clinically prescribed, SIMV with baseline settings (SIMVBL), 2) neurally adjusted ventilatory assist, 3) same as SIMVBL, but with an adjustment of the inspiratory time of the mandatory breaths (SIMV with adjusted settings [SIMVADJ]) using feedback from the electrical activity of the diaphragm)...
January 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29115949/neurally-adjusted-ventilatory-assist-nava-or-pressure-support-ventilation-psv-during-spontaneous-breathing-trials-in-critically-ill-patients-a-crossover-trial
#11
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/29077984/neurally-adjusted-ventilatory-assist-compared-to-other-forms-of-triggered-ventilation-for-neonatal-respiratory-support
#12
REVIEW
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
https://www.readbyqxmd.com/read/29072677/the-impact-of-neurally-adjusted-ventilatory-assist-mode-on-respiratory-severity-score-and-energy-expenditure-in-infants-a-randomized-crossover-trial
#13
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...
January 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29059880/evaluation-of-indirect-measures-of-neural-inspiratory-time-from-invasive-and-noninvasive-recordings-of-respiratory-activity
#14
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
https://www.readbyqxmd.com/read/28977137/dorsal-brainstem-syndrome-and-the-use-of-neurally-adjusted-ventilatory-assist-nava-in-an-infant
#15
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...
January 2018: Revista Paulista de Pediatria: Orgão Oficial da Sociedade de Pediatria de São Paulo
https://www.readbyqxmd.com/read/28914623/prevalence-and-prognosis-impact-of-patient-ventilator-asynchrony-in-early-phase-of-weaning-according-to-two-detection-methods
#16
RANDOMIZED CONTROLLED TRIAL
Camille Rolland-Debord, Côme Bureau, Tymothee Poitou, Lisa Belin, Marc Clavel, Sébastien Perbet, Nicolas Terzi, Achille Kouatchet, Thomas Similowski, Alexandre Demoule
BACKGROUND: Patient-ventilator asynchrony is associated with a poorer outcome. The prevalence and severity of asynchrony during the early phase of weaning has never been specifically described. The authors' first aim was to evaluate the prognosis impact and the factors associated with asynchrony. Their second aim was to compare the prevalence of asynchrony according to two methods of detection: a visual inspection of signals and a computerized method integrating electromyographic activity of the diaphragm...
December 2017: Anesthesiology
https://www.readbyqxmd.com/read/28683763/new-setting-of-neurally-adjusted-ventilatory-assist-for-noninvasive-ventilation-by-facial-mask-a-physiologic-study
#17
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
https://www.readbyqxmd.com/read/28673877/remifentanil-effects-on-respiratory-drive-and-timing-during-pressure-support-ventilation-and-neurally-adjusted-ventilatory-assist
#18
RANDOMIZED CONTROLLED TRIAL
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)...
October 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28608135/can-proportional-ventilation-modes-facilitate-exercise-in-critically-ill-patients-a-physiological-cross-over-study-pressure-support-versus-proportional-ventilation-during-lower-limb-exercise-in-ventilated-critically-ill-patients
#19
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
https://www.readbyqxmd.com/read/28578708/effects-of-neurally-adjusted-ventilatory-assist-on-air-distribution-and-dead-space-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#20
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
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