Neurally Adjusted Ventilatory Assist in Preterm Neonates with Acute Respiratory Failure

作者：Longhini Federico; Ferrero Federica; De Luca Daniele; Cosi Gianluca; Alemani Moreno; Colombo Davide; Cammarota Gianmaria; Berni Paola; Conti Giorgio; Bona Gianni; Della Corte Francesco; Navalesi Paolo^*

来源：Neonatology, 2015, 107(1): 60-67.

DOI：10.1159/000367886

• Mechanical ventilation
• Premature infant
• Respiratory insufficiency
• Neurally adjusted ventilatory assist

Background: Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that has been demonstrated to improve infant-ventilator interaction, compared to the conventional modes in retrospective and short-term studies. Objectives: To prospectively evaluate the physiologic effects of NAVA in comparison with pressure-regulated volume control (PRVC) in two nonrandomized 12-hour periods. Methods: We studied 14 consecutive intubated preterm neonates receiving mechanical ventilation for acute respiratory failure. Peak airway pressure (Paw(peak)), diaphragm electrical activity (EAdi), tidal volume (V-T), mechanical (RRmec) and neural (RRneu) respiratory rates, neural apneas, and the capillary arterialized blood gases were measured. The RRmec-to-RRneu ratio (MNR) and the asynchrony index were also calculated. The amount of fentanyl administered was recorded. Results: Paw(peak) and V-T were greater in PRVC (p < 0.01). Blood gases and RRmec were not different between modes, while RRneu and the EAdi swings were greater in NAVA (p = 0.02 and p < 0.001, respectively). MNR and the asynchrony index were remarkably lower in NAVA than in PRVC (p = 0.03 and p < 0.001, respectively). 1,841 neural apneas were observed during PRVC, with none in NAVA. Less fentanyl was administered during NAVA, as opposed to PRVC (p < 0.01). Conclusions: In acutely ill preterm neonates, NAVA can be safely and efficiently applied for 12 consecutive hours. Compared to PRVC, NAVA is well tolerated with fewer sedatives.

• 出版日期2015