Effect of neurally adjusted ventilatory assist and pressure support ventilation on respiratory pattern of patients with acute respiratory failure

doi:10.3877/cma.j.issn.2096-1537.2021.02.005

Abstract

Abstract:

Objective

To determine the effect of neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) on respiratory pattern in patients with acute respiratory failure (ARF).

Methods

12 ARF patients received mechanical ventilation admitted in Department of Critical Care Medicine of Northern Jiangsu People's Hospital from January 2018 to June 2019 were enrolled in the study. Patients were. randomly received NAVA and PSV. The ventilation support level of NAVA and PSV started from 5 cmH₂O and increased in four steps every 10 min. The pressure support levels in PSV group were 5, 10, 15 and 20 cmH₂O, respectively. The NAVA level were 1, 2, 3 and 4 times of the initial NAVA level in NAVA group. Parameters of the respiratory pattern and gas exchange were recorded at the same time at each time point of PSV and NAVA group.

Results

(1) As ventilation support levels increase, the tidal volume (Vt), invalid trigger increased significantly, VRR, NRR decreased significantly in PSV1-4 (F=13.471, F=30.521, F=13.672, F=9.357, P＜0.05); VT in PSV3-4 increased significantly compared with NAVA3-4 in concurrent point , invalid trigger in PSV4 increased significantly compared with NAVA4 (P＜0.05); the comparison of VT in each points in NAVA1-4 were not statistically significant (P＞0.05). (2) Ti-neu at each point in PSV1-4, and T_i-flow, T_e-flow， T_i-neu, T_e-neu in the NAVA1-4 had no statistical significance (P＞0.05); the in-group comparison with T_i-flow, T_e-flow, T_e-neu in PSV1-4 had significant differences (F=9.564, F=13.431, F=21.126, P＜0.05); T_i-flow, T_e-flow, T_e-neu in PSV4 was significantly higher than that in NAVA4, respectively (P＜0.05). (3) The Vt variability in NAVA group (21.7%±9.3%) was significantly higher than that in PSV group (10.7%±4.8%) (F=13.136,P＜0.05). The peak airway pressure (Ppeak) in NAVA group was always closely related to the diaphragm electrical activity (EAdi) (r=0.96±0.14,P＜0.05). (4) The arterial blood carbon dioxide (PaCO₂) in PSV4 was significantly lower than that in PSV1 (P＜0.05).

Conclusion

Compared with PSV, the ventilation time and the support level in NAVA were more compatible with patient's own breathing pattern, and NAVA had less effects on the physiological breathing pattern and might avoid insufficient or hyperinflation to some extent.

Key words: Diaphragm electrical activity, Mechanical ventilation, Pressure support, Respiratory pattern, Acute respiratory failure

Xiaoyan Wu, Fengdi Yan, Jingjing Yin, Jiangquan Yu, Ruiqiang Zheng. Effect of neurally adjusted ventilatory assist and pressure support ventilation on respiratory pattern of patients with acute respiratory failure[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(02): 120-125.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.02.005

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I02/120

Figures/Tables 3

References 17

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组别	压力支持水平（cmH₂O）	NAVA支持水平（cmH₂O/μv）	V_T（ml/kg）	Ppeak（cmH₂O）	VRR（次/分）	NRR（次/分）	EAdi_peak（μv）	pH	P/F（mmHg）	PaCO₂（mmHg）	无效触发（%）
NAVA1组	-	0.55±0.10	4.69±0.44	10.17±0.78	30.31±3.46	30.45±4.34	9.07±2.39	7.38±0.04	278±42	46±6	0.0±0.0
NAVA2组	-	1.10±0.21	5.46±0.57	13.63±1.28	28.76±2.65	28.76±2.47	7.91±2.18	7.39±0.04	274±45	45±5	0.0±0.0
NAVA3组	-	1.65±0.32	5.88±0.74	15.12±1.65	27.12±5.73	27.23±3.78	6.39±1.58	7.38±0.04	282±62	43±7	0.0±0.0
NAVA4组	-	2.20±0.42	6.16±0.82	16.98±2.53	26.01±3.48	26.12±3.41	5.45±1.09	7.39±0.01	280±57	43±6	0.0±0.0
PSV1组	5	-	4.56±0.55	10.08±0.94	29.12±3.75	29.51±4.06	8.56±2.54	7.36±0.02	267±65	48±4	1.3±0.4
PSV2组	10	-	5.72±0.72	14.59±0.88	24.89±3.24	25.28±2.13	6.89±2.64	7.38±0.04	284±62	42±9	2.5±0.4
PSV3组	15	-	7.41±1.03^abc	20.08±1.37^b	18.46±3.34^abc	19.67±2.81^abc	5.13±1.85^ab	7.40±0.03	289±57	40±7	6.2±1.9^abc
PSV4组	20	-	9.15±1.31^abc	24.95±1.66^abc	12.08±2.19^abc	14.26±2.08^abc	3.35±1.44^abc	7.41±0.05	292±39	37±7^b	15.3±3.6^abc

组别	压力支持水平（cmH₂O）	NAVA支持水平（cmH₂O/μv）	V_T（ml/kg）	Ppeak（cmH₂O）	VRR（次/分）	NRR（次/分）	EAdi_peak（μv）	pH	P/F（mmHg）	PaCO₂（mmHg）	无效触发（%）
NAVA1组	-	0.55±0.10	4.69±0.44	10.17±0.78	30.31±3.46	30.45±4.34	9.07±2.39	7.38±0.04	278±42	46±6	0.0±0.0
NAVA2组	-	1.10±0.21	5.46±0.57	13.63±1.28	28.76±2.65	28.76±2.47	7.91±2.18	7.39±0.04	274±45	45±5	0.0±0.0
NAVA3组	-	1.65±0.32	5.88±0.74	15.12±1.65	27.12±5.73	27.23±3.78	6.39±1.58	7.38±0.04	282±62	43±7	0.0±0.0
NAVA4组	-	2.20±0.42	6.16±0.82	16.98±2.53	26.01±3.48	26.12±3.41	5.45±1.09	7.39±0.01	280±57	43±6	0.0±0.0
PSV1组	5	-	4.56±0.55	10.08±0.94	29.12±3.75	29.51±4.06	8.56±2.54	7.36±0.02	267±65	48±4	1.3±0.4
PSV2组	10	-	5.72±0.72	14.59±0.88	24.89±3.24	25.28±2.13	6.89±2.64	7.38±0.04	284±62	42±9	2.5±0.4
PSV3组	15	-	7.41±1.03^abc	20.08±1.37^b	18.46±3.34^abc	19.67±2.81^abc	5.13±1.85^ab	7.40±0.03	289±57	40±7	6.2±1.9^abc
PSV4组	20	-	9.15±1.31^abc	24.95±1.66^abc	12.08±2.19^abc	14.26±2.08^abc	3.35±1.44^abc	7.41±0.05	292±39	37±7^b	15.3±3.6^abc

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