Critical Care Medicine  |   December 2016
New Setting of Neurally Adjusted Ventilatory Assist during Noninvasive Ventilation through a Helmet
Author Notes
  • From the Anesthesia and Intensive Care, “Maggiore della Carità” Hospital, Novara, Italy (G.C., R.P., D.C., A.M., R.V.); Anesthesia and Intensive Care, Sant’Andrea Hospital, ASL VC, Vercelli, Italy (F.L., P.N.); Department of Translational Medicine, Eastern Piedmont University “A. Avogadro,” Novara, Italy (C.R., P.N.); and CRRF Mons. L. Novarese, Moncrivello, Italy (P.N.).
  • Submitted for publication April 12, 2016. Accepted for publication August 22, 2016.
    Submitted for publication April 12, 2016. Accepted for publication August 22, 2016.×
  • Part of the results of this study has been presented as an abstract at the European Society of Intensive Care Medicine Congress in Paris, October 5–9, 2013, and at the 34th International Symposium on Intensive Care and Emergency Medicine in Brussels, Belgium, March 18–21, 2014. G.C. and F.L. contributed equally to this article.
    Part of the results of this study has been presented as an abstract at the European Society of Intensive Care Medicine Congress in Paris, October 5–9, 2013, and at the 34th International Symposium on Intensive Care and Emergency Medicine in Brussels, Belgium, March 18–21, 2014. G.C. and F.L. contributed equally to this article.×
  • Address correspondence to Dr. Navalesi: Department of Translational Medicine, Eastern Piedmont University “A. Avogadro,” Via Solaroli 17, 28100, Novara, Italy. paolo.navalesi@med.uniupo.it. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Clinical Science / Airway Management / Critical Care / Respiratory System
Critical Care Medicine   |   December 2016
New Setting of Neurally Adjusted Ventilatory Assist during Noninvasive Ventilation through a Helmet
Anesthesiology 12 2016, Vol.125, 1181-1189. doi:10.1097/ALN.0000000000001354
Anesthesiology 12 2016, Vol.125, 1181-1189. doi:10.1097/ALN.0000000000001354
Abstract

Background: Compared to pneumatically controlled pressure support (PSP), neurally adjusted ventilatory assist (NAVA) was proved to improve patient–ventilator interactions, while not affecting comfort, diaphragm electrical activity (EAdi), and arterial blood gases (ABGs). This study compares neurally controlled pressure support (PSN) with PSP and NAVA, delivered through two different helmets, in hypoxemic patients receiving noninvasive ventilation for prevention of extubation failure.

Methods: Fifteen patients underwent three (PSP, NAVA, and PSN) 30-min trials in random order with both helmets. Positive end-expiratory pressure was always set at 10 cm H2O. In PSP, the inspiratory support was set at 10 cm H2O above positive end-expiratory pressure. NAVA was adjusted to match peak EAdi (EAdipeak) during PSP. In PSN, the NAVA level was set at maximum matching the pressure delivered during PSP by limiting the upper pressure. The authors assessed patient comfort, EAdipeak, rates of pressurization (i.e., airway pressure-time product [PTP] of the first 300 and 500 ms after the initiation of patient effort, indexed to the ideal pressure–time products), and measured ABGs.

Results: PSN significantly increased comfort to (median [25 to 75% interquartile range]) 8 [7 to 8] and 9 [8 to 9] with standard and new helmets, respectively, as opposed to both PSP (5 [5 to 6] and 7 [6 to 7]) and NAVA (6 [5 to 7] and 7 [6 to 8]; P < 0.01 for all comparisons). Regardless of the interface, PSN also decreased EAdipeak (P < 0.01), while increasing PTP of the first 300 ms from the onset of patient effort, indexed to the ideal PTP (P < 0.01) and PTP of the first 500 ms from the onset of patient effort, indexed to the ideal PTP (P < 0.001). ABGs were not different among trials.

Conclusions: When delivering noninvasive ventilation by helmet, compared to PSP and NAVA, PSN improves comfort and patient–ventilator interactions, while not ABGs. (Anesthesiology 2016; 125:1181-9)