The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

PROSPECTIVE COMPARISON BETWEEN NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA) AND CONVENTIONAL MECHANICAL VENTILATION IN PRETERM NEONATES.

Jose Batista1, Robert Tero1, Shyann Sun2; 1Respiratory Care, Saint Barnabas Medical Center, Livingston, NJ; 2Division of Neonatology, Saint Barnabas Medical Center, Livingston, NJ

BACKGROUND: A new mode of mechanical ventilation, NAVA allows a patient to synchronize spontaneous respiratory effort with mechanical ventilation. Electrodes imbedded within the tip of a nasogastric tube detect the electrical activity of the diaphragm (Edi) and transmit this information to the ventilator. The ventilator breath is triggered and terminated by changes in electrical activity. The patient therefore determines respiratory rate, tidal volumes, peak pressure, inspiratory and expiratory times in synchrony with the ventilator. OBJECTIVE: To evaluate the efficacy of NAVA ventilation compared to that of conventional mechanical ventilation (CMV) in preterm infants. DESIGN/METHOD: A prospective observational study comparing between NAVA and conventional Pressure Control / SIMV with pressure support ventilation. Seven preterm infants were enrolled (mean gestational age 25.7 wk, range 24 - 27 wk, mean birth weight 746g, range 470 -1245g). All had Respiratory Distress Syndrome. Each baby was ventilated with CMV for at least 30 min. then switched to NAVA for 30 min. The target is to maintain SpO2 between 85 to 93% and PCO2 between 40 to 50 mmHg. A steady state peak inspiratory pressure (PIP), Mean airway pressure (MAP) and FiO2 were recorded during two different periods of ventilation. RESULT:
Sponsored Research - None
NAVA compared with CMV
Compared to CMV, Neonates on NAVA required 30% less PIP, 16% less MAP, and 8% less FiO2
There was no inspiratory / expiratory mismatch and neonates appeared more comfortable on NAVA.
CONCLUSION: Preterm neonates on NAVA required less inspiratory pressure and less oxygen concentration. These may indicate less ventilation induced lung injury and less oxidative stress (oxygen toxicity). Further studies are needed to demonstrate whether these beneficial effects will lead to reduced ventilator days, reduced BPD, and shortened length of NICU stay.