The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

NEONATES VENTILATED WITH NAVA HAVE BETTER BLOOD GASES THAN THOSE VENTILATED WITH SIMV/PC WITH PRESSURE SUPPORT

Diane Howard, Howard Stein; Toledo Children’s Hospital, Toledo, OH

Background: Neurally Adjusted Ventilatory Assist (NAVA) allows a patient to synchronize spontaneous respiratory effort with mechanical ventilation. Electrodes within a nasogastric tube detect the electrical activity of the diaphragm and transmit this information to the ventilator. The ventilator breath is triggered and terminated by changes in this electrical activity. The ventilator determines the inspiratory pressure in proportion to this electrical signal. The patient therefore determines respiratory rate, tidal volumes, peak pressures, inspiratory and expiratory times in total synchrony with the ventilator. There is currently no data about the ability of neonates to ventilate on NAVA. We hypothesized that NAVA is as effective as conventional ventilation using SIMV/PC with PS (CV) in ventilating neonates as evaluated by blood gases. Methods: From May 2008 – May 2009 we ventilated 87 neonates on NAVA ranging from 22 to 40 weeks gestation and birth weight 500-3930 grams. 85% had Respiratory Distress Syndrome or Chronic Lung Disease. Initially neonates were ventilated with CV and were then changed to NAVA at the discretion of the treating physician. We compared both the pH and CO2 levels on CV to those on NAVA. Statistics were 2 tailed t-test. Significant differences were at a p value < 0.05. Results: Both pre and post blood gases were obtained from 66 of the 87 patients. Patients who had an initial pH < 7.38 or pCO2 > 45 were considered under-ventilated and pH > 7.42 or pCO2 < 35 were considered over-ventilated on CV. After the initiation of NAVA, both over and under-ventilated groups significantly corrected their pH and pCO2 closer to the normal range (Table 1). Patients with normal pH (7.38 - 7.42) or pCO2 (35 - 45) remained unchanged (Table 1). Conclusion: We conclude that neonates have the capacity to ventilate better on NAVA as compared to CV. The neonatal brainstem appears sufficiently mature enough to regulate ventilation effectively on NAVA, achieving blood gases that approach the normal range in both under- and over-ventilated neonates. Sponsored Research - None

pH and pCO2 values on SIMV/PC with PS compared to NAVA

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