The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

CASE SERIES: REPORT OF PATIENTS AT OUR INTSTITUTION VENTILATED IN NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA) WITH SEVERE OBSTRUCTIVE PHYSIOLOGY

Brandy Seger, Carrie Morgan, Cynthia White, Alicia West; PICU, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Introduction: An advantage of NAVA is the introduction of an electrical trigger offering physiological breath cycle synchrony in comparison to pressure or flow triggering. Several small studies now report the use of NAVA in the pediatric population, but none of these mention NAVA in conditions with severe obstructive conditions such as asthma. The following case series will present 3 patients that were ventilated in NAVA with obstructive physiology resulting in prolonged exhalation. Case Report: Patient 1 is a 3 yr old female admitted with status asthmaticus and pneumonia with a history of reactive airway disease (RAD). On PD (patient day) 2 she was intubated, placed on conventional ventilation, received continuous albuterol, solumedrol, and magnesium sulfate. While on the ventilator she received multiple doses of a neuromuscular blockade(NMB)to prevent patient ventilator asynchrony (PVA). PD 5 Nitric Oxide (NO) was initiated to optimize her oxygenation and she was transitioned to NAVA to improve PVA. PD 7 she was extubated. Patient 2 is an 18 month old 7.2 kg, former 30 week preemie with chronic lung disease (CLD) and RAD, female admitted to the PICU with pneumonia. PD 2 she was intubated and received continuous albuterol and solumedrol. Throughout her course she was placed on high frequency oscillatory ventilation (HFOV) and NO for oxygenation and ventilation, received multiple doses of NMB, and an ECMO consultation. PD 11 she was transitioned back to conventional ventilation, PD 17 she was placed in NAVA remaining on 20 ppm NO, and PD 21 she was extubated. Patient 3 is a 6 yr old 18.8 kg asthmatic male that was admitted for pulmonary hemorrhage. On PD 1 he was intubated and treated for an anomalous aorta to pulmonary artery fistula. PD 5 he became septic having frequent and prolonged episodes of desaturations requiring him to be placed on HFOV, NO of 20 ppm, and surfactant administration. PD 11 he was transitioned to conventional ventilation and placed on continuous albuterol. PD 13 he was placed into NAVA and on PD 16 he was extubated. Discussion: NAVA appears to be a safe mode of ventilation for patients that have obstructive lung disease. Our 3 pediatric NAVA patients with obstructive disease components were successfully extubated and able to self regulate their I:E ratio, maintain adequate Vt’s, C02, and oxygenation in NAVA. Further studies are needed to show the benefits of NAVA in pediatric patients with obstructive disease components. Sponsored Research - None

NAVA Data