Noninvasive Neurally Adjusted Ventilatory Assist Versus High Flow Cannula Support After Congenital Heart Surgery

Abstract

Background:

Extubation failure rates for critical patients in pediatric intensive care units (ICUs) range from 5% to 29%. Noninvasive (NIV) ventilation has been shown to decrease extubation failure. We compared reintubation rates and outcomes of patients supported with NIV neurally adjusted ventilation assist (NAVA) versus historical controls supported with high-flow nasal cannula (HFNC).

Methods:

Case–control study of infants less than three months of age who underwent cardiac surgery and received NIV support after extubation from January 2011 to May 2017. All patients supported with NIV NAVA after it became available in September 2013 were compared to matched patients extubated to HFNC from prior to September 2013.

Results:

Forty-two patients identified for the NIV NAVA group were matched with 42 historical controls supported with HFNC. Groups had similar baseline characteristics based on rate of acute kidney injury, number of single ventricle patients, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, age, weight, bypass time, and duration of intubation. There was no significant difference in reintubation rates within 72 hours (14.3% in the HFNC group and 16.7% in the NIV NAVA group, P = 1.0). Median duration from extubation to coming off NIV support was longer in the NIV NAVA group (3.6 days vs 0.6 days, P < .001). Median time from extubation to ICU discharge was longer in the NIV NAVA group (10.5 vs 6.8 days, P = .02), as was total postoperative ICU length of stay (LOS; 17.6 vs 12.2, P = .01).

Conclusions:

Introduction of NIV NAVA for postextubation support did not reduce reintubation rates compared to HFNC. Further study is needed as adoption of NIV NAVA may prolong LOS.

Keywords

reintubation ventilation congenital heart surgery outcomes (includes mortality morbidity)postoperative care pediatric intensive care

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References

Lemyre

Laughon

Bose

Davis

. Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants. Cochrane Database Syst Rev. 2016;12:CD005384.

Stein

Beck

Dunn

. Non-invasive ventilation with neurally adjusted ventilatory assist in newborns. Semin Fetal Neonatal Med. 2016;21(3):154–161.

Gaies

Tabbutt

Schwartz

, et al. Clinical epidemiology of extubation failure in the pediatric cardiac ICU: a report from the pediatric cardiac critical care consortium. Pediatr Crit Care Med. 2015;16(9):837–845.

Mastropietro

Cashen

Grimaldi

, et al. Extubation failure after neonatal cardiac surgery: a multicenter analysis. J Pediatr. 2017;182:190–196 e4.

Benneyworth

Mastropietro

Graham

, et al. Variation in extubation failure rates after neonatal congenital heart surgery across pediatric cardiac critical care consortium hospitals. J Thorac Cardiovasc Surg. 2017;153(6):1519–1526.

Wratney

Benjamin

Jr Slonim

Hamel

Cheifetz

. The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients. Pediatr Crit Care Med. 2008;9(5):490–496.

Houtekie

Moerman

Bourleau

, et al. Feasibility study on neurally adjusted ventilatory assist in noninvasive ventilation after cardiac surgery in infants. Respir Care. 2015;60(7):1007–1014.

Lemyre

Davis

De Paoli

Kirpalani

. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev. 2014;(9):CD003212.

Vignaux

Grazioli

Piquilloud

, et al. Patient-ventilator asynchrony during noninvasive pressure support ventilation and neurally adjusted ventilatory assist in infants and children. Pediatr Crit Care Med. 2013;14(8):e357–364.

10.

Shoemaker

Pierce

Yoder

DiGeronimo

. High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol. 2007;27(2):85–91.

11.

Ducharme-Crevier

Beck

Essouri

Jouvet

Emeriaud

. Neurally adjusted ventilatory assist (NAVA) allows patient-ventilator synchrony during pediatric noninvasive ventilation: a crossover physiological study. Crit Care. 2015;19:44.

12.

Harris

Taylor

Thielke

Payne

Gonzalez

Conde

. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.

13.

Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Inter Suppl. 2012;2:8–12.

14.

Kogon

Oster

. Assessing surgical risk for adults with congenital heart disease: are pediatric scoring systems appropriate? J Thorac Cardiovasc Surg. 2014;147(2):666–671.

15.

Delpachitra

Namachivayam

Millar

Delzoppo

Butt

. A case-control analysis of postoperative fluid balance and mortality after pediatric cardiac surgery. Pediatr Crit Care Med. 2017;18(7):614–622.

16.

Costa

Schettino Rde

Ferreira

. Predictors of extubation failure and reintubation in newborn infants subjected to mechanical ventilation [in Portuguese]. Rev Bras Ter Intensiva. 2014;26(1):51–56.

17.

Edmunds

Weiss

Harrison

. Extubation failure in a large pediatric ICU population. Chest. 2001;119(3):897–900.

18.

Kurachek

Newth

Quasney

, et al. Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes. Crit Care Med. 2003;31(11):2657–2664.

19.

Harkel

van der Vorst

Hazekamp

Ottenkamp

. High mortality rate after extubation failure after pediatric cardiac surgery. Pediatr Cardiol. 2005;26(6):756–761.

20.

Fontela

Piva

Garcia

Bered

Zilles

. Risk factors for extubation failure in mechanically ventilated pediatric patients. Pediatr Crit Care Med. 2005;6(2):166–170.