Noninvasive ventilation (NIV) is commonly used in neonates. A mode of NIV called neurally adjusted ventilatory assist (NAVA) offers patient-ventilator interactions by using electrical activity of the diaphragm to control mechanical breaths. We hypothesized that the work of breathing (WOB) would decrease with NIV-NAVA. Secondary objectives evaluated the impact of NIV-NAVA on arterial blood gases and respiratory parameters.
METHODS:
We compared WOB between synchronized breaths in NIV-NAVA and NIV in piglets with healthy lungs and then with surfactant-depleted lungs. Neonatal pigs (median, 2.0 [range, 1.8–2.4] kg) with healthy and then surfactant depleted lungs were sedated and ventilated with NIV-NAVA and NIV in random order. Airway flow and pressure waveforms were acquired. Waveforms were analyzed for the pressure-time product that reflected WOB. The primary outcome between modes was assessed with repeated measurement analysis of variance.
RESULTS:
The pressure-time product was significantly decreased for NIV-NAVA in both healthy and injured lungs (P < .001). PaO2, PaCO2, inspiratory tidal volume, and peak inspiratory flow were not different in either model.
CONCLUSIONS:
Synchronized breaths during NIV-NAVA resulted in decreased WOB compared with synchronized breaths during NIV.
BadieeZ, NekooieB, MohammadizadehM. Noninvasive positive pressure ventilation or conventional mechanical ventilation for neonatal continuous positive airway pressure failure. Int J Prev Med, 2014; 5(8):1045–1053.
2.
MillerJD, CarloWA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol, 2008; 35(1):273–281, x–xi.
3.
Rojas-ReyesMX, LozanoJM, SolàI, SollR. Overview of ventilation strategies for the early management of intubated preterm infants (Protocol). Cochrane Database Syst Rev, 2015;(4):CD011663.
4.
MitsiakosG, PapageorgiouA. Incidence and factors predisposing to retinopathy of prematurity in inborn infants less than 32 weeks of gestation. Hippokratia, 2016; 20(2):121–126.
5.
HwangJH, LeeEH, KimEA. Retinopathy of prematurity among very-low-birth-weight infants in Korea: incidence, treatment, and risk factors. J Korean Med Sci, 2015; 30(Suppl 1):S88–S94.
6.
Committee on Fetus and Newborn. Respiratory support in preterm infants at birth. Pediatrics, 2014; 133(1):171–174.
7.
VendettuoliV, BellùR, ZaniniR, MoscaF, GagliardiL. Italian Neonatal Network). Changes in ventilator strategies and outcomes in preterm infants. Arch Dis Child Fetal Neonatal Ed, 2014; 99(4):F321–F324.
8.
BancalariE, ClaureN. The evidence for non-invasive ventilation in the preterm infant. Arch Dis Child Fetal Neonatal Ed, 2013; 98(2):F98–F102.
9.
LemyreB, DavisPG, De PaoliAG, KirpalaniH. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev, 2017; 2:CD003212.
10.
SteinH, BeckJ, DunnM. Non-invasive ventilation with neurally adjusted ventilatory assist in newborns. Semin Fetal Neonatal Med, 2016; 21(3):154–161.
11.
SteinH, FirestoneK. Application of neurally adjusted ventilatory assist in neonates. Semin Fetal Neonatal Med, 2014; 19(1):60–69.
12.
BeckJ, BranderL, SlutskyAS, ReillyMC, DunnMS, SinderbyC. Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury. Intensive Care Med, 2008; 34(2):316–323.
BeckJ, EmeriaudG, LiuY, SinderbyC. Neurally adjusted ventilatory assist (NAVA) in children: a systematic review. Minerva Anestesiol, 2016; 82(8):874–883.
17.
SchmidG, PfitzerP. Mitoses and binucleated cells in perinatal human hearts. Virchows Arch B Cell Pathol Incl Mol Pathol, 1985; 48(1):59–67.
18.
PondWG, BolemanSL, FiorottoML, HoH, KnabeDA, MersmannHJ, et al. Perinatal ontogeny of brain growth in the domestic pig. Proc Soc Exp Biol Med, 2000; 223(1):102–108.
19.
WilliamsSM, SullivanRK, ScottHL, FinkelsteinDI, ColditzPB, LingwoodBE, et al. Glial glutamate transporter expression patterns in brains from multiple mammalian species. Glia, 2005; 49(4):520–541.
20.
BjörkmanST, MillerSM, RoseSE, BurkeC, ColditzPB. Seizures are associated with brain injury severity in a neonatal model of hypoxia-ischemia. Neuroscience, 2010; 166(1):157–167.
21.
EibyYA, WrightLL, KalanjatiVP, MillerSM, BjorkmanST, KeatesHL, et al. A pig model of the preterm neonate: anthropometric and physiological characteristics. PLoS One, 2013; 8(7):e68763.
22.
LachmannB, RobertsonB, VogelJ. In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Anaesthesiol Scand, 1980; 24(3):231–236.
23.
HansonA, GöthbergS, NilssonK, LarssonLE, HedenstiernaG. VTCO2 and dynamic compliance-guided lung recruitment in surfactant-depleted piglets: a computed tomography study. Pediatr Crit Care Med, 2009; 10(6):687–692.
24.
NilsestuenJO, HargettKD. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care, 2005; 50(2):202–234; discussion 232-234.
25.
HeulittM, CourtneyS. Pediatric and Neonatal Mechanical Ventilation: From Basics to Clinical Practice. Heidelberg: Springer; 2015:338–340.
26.
HeulittM, CourtneyS. Pediatric and Neonatal Mechanical Ventilation: From Basics to Clinical Practice. Heidelberg: Springer; 2015:346–348.
27.
CollettPW, PerryC, EngelLA. Pressure-time product, flow, and oxygen cost of resistive breathing in humans. J Appl Physiol, 1985; 58(4):1263–1272.
28.
McGregorM, BecklakeMR. The relationship of oxygen cost of breathing to respiratory mechanical work and respiratory force. J Clin Invest, 1961; 40:971–980.
29.
FieldS, SanciS, GrassinoA. Respiratory muscle oxygen consumption estimated by the diaphragm pressure-time index. J Appl Physiol Respir Environ Exerc Physiol, 1984; 57(1):44–51.
30.
ChenZ, LuoF, MaXL, LinHJ, ShiLP, DuLZ. Application of neurally adjusted ventilatory assist in preterm infants with respiratory distress syndrome [in Chinese with English abstract]. Zhongguo Dang Dai Er Ke Za Zhi. 2013; 15(9):709–712.
