J Clin Monit Comput - NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand.


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Neurally adjusted ventilatory assist (NAVA) is a ventilation assist mode that delivers pressure in proportionality to electrical activity of the diaphragm (Eadi). Compared to pressure support ventilation (PS), it improves patient-ventilator synchrony and should allow a better expression of patient's intrinsic respiratory variability. We hypothesize that NAVA provides better matching in ventilator tidal volume (Vt) to patients inspiratory demand. 22 patients with acute respiratory failure, ventilated with PS were included in the study. A comparative study was carried out between PS and NAVA, with NAVA gain ensuring the same peak airway pressure as PS. Robust coefficients of variation (CVR) for Eadi and Vt were compared for each mode. The integral of Eadi (Eadi) was used to represent patient's inspiratory demand. To evaluate tidal volume and patient's demand matching, Range90 = 5-95 % range of the Vt/Eadi ratio was calculated, to normalize and compare differences in demand within and between patients and modes. In this study, peak Eadi and Eadi are correlated with median correlation of coefficients, R > 0.95. Median Eadi, Vt, neural inspiratory time (Ti_ ( Neural )), inspiratory time (Ti) and peak inspiratory pressure (PIP) were similar in PS and NAVA. However, it was found that individual patients have higher or smaller Eadi, Vt, Ti_ ( Neural ), Ti and PIP. CVR analysis showed greater Vt variability for NAVA (p < 0.005). Range90 was lower for NAVA than PS for 21 of 22 patients. NAVA provided better matching of Vt to Eadi for 21 of 22 patients, and provided greater variability Vt. These results were achieved regardless of differences in ventilatory demand (Eadi) between patients and modes.

Resumo Limpo

neural adjust ventilatori assist nava ventil assist mode deliv pressur proport electr activ diaphragm eadi compar pressur support ventil ps improv patientventil synchroni allow better express patient intrins respiratori variabl hypothes nava provid better match ventil tidal volum vt patient inspiratori demand patient acut respiratori failur ventil ps includ studi compar studi carri ps nava nava gain ensur peak airway pressur ps robust coeffici variat cvr eadi vt compar mode integr eadi eadi use repres patient inspiratori demand evalu tidal volum patient demand match rang rang vteadi ratio calcul normal compar differ demand within patient mode studi peak eadi eadi correl median correl coeffici r median eadi vt neural inspiratori time ti neural inspiratori time ti peak inspiratori pressur pip similar ps nava howev found individu patient higher smaller eadi vt ti neural ti pip cvr analysi show greater vt variabl nava p rang lower nava ps patient nava provid better match vt eadi patient provid greater variabl vt result achiev regardless differ ventilatori demand eadi patient mode

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