Volume 18 Supplement 1

34th International Symposium on Intensive Care and Emergency Medicine

Open Access

A new setting to improve noninvasive neurally adjusted ventilatory assist by helmet

  • F Longhini1,
  • G Cammarota1,
  • C Olivieri1,
  • R Perucca1,
  • R Vaschetto1,
  • D Colombo1,
  • A Messina1,
  • F Della Corte1 and
  • P Navalesi1
Critical Care201418(Suppl 1):P269

https://doi.org/10.1186/cc13459

Published: 17 March 2014

Introduction

Noninvasive neurally adjusted ventilatory assist by helmet (hNAVA) was shown to improve, compared with pressure support ventilation by helmet (hPSV), patient-ventilator interaction and synchrony in patients with acute respiratory failure without affecting peak electrical activity of the diaphragm (EAdipeak) [1]. Recently, a new helmet is available, which improves pressurization during hPSV. We propose a new setting of hNAVA (hNAVA15) to achieve further improvement. We compare hPSV, hNAVA and hNAVA15, all delivered using the new helmet, with respect to patient's dyspnea, assessed by a visual analogue scale (VASd), arterial blood gases (ABGs), EAdipeak, rate of ventilator pressurization and triggering performance.

Methods

Fifteen patients underwent three randomized 30-minute trials: hPSV, set with an inspiratory support above positive end- expiratory pressure (PEEP) ≥ 10 cmH2O and the fastest rate of pressurization; hNAVA, setting the NAVA level to achieve the same EAdipeak as during hPSV; hNAVA15 setting the NAVA level at 15 cmH2O/μV and the maximum inspiratory airway pressure (Paw) at the value corresponding to PEEP + inspiratory support during nPSV. Oxygen inspiratory fraction and PEEP remained unmodified throughout the study period. Paw-time products of the initial 200 ms from the onset of ventilator pressurization (PTP200), of the initial 500 ms from the onset of the EAdi swing indexed to the ideal PTPaw (PTP500i), and of the triggering area (PTPt) were computed. ABGs and VASd were assessed at the end of each trial.

Results

hNAVA15 reduced the EAdipeak (10.2 (7.1; 16.2) μV) with respect to both hPSV (16.9 (12.7; 19.8) μV P < 0.001) and hNAVA (15.3 (10.7; 18.8) μV P < 0.001), while decreasing VASd (3.0 (3.0; 4.0) in hPSV, 3. (2.0; 4.0) in hNAVA and 1.0 (1.0; 2.0) in hNAVA15; P < 0.01). PTP200 and PTP500i were improved by hNAVA15 (36 (28; 57) cmH2O*second and 40 (30; 47)%, respectively) compared with hPSV (31 (24; 45) cmH2O*second and 17 (9; 26)%, respectively) and hNAVA (23 (16; 30) cmH2O*second and 23 (17; 37)%, respectively) (P < 0.01). PTPt was lower in hNAVA15 (2.9 (1.6; 4.4) cmH2O*second, P < 0.01) compared with both hPSV and hNAVA, and lower in hNAVA (6.0 (2.7; 11.6) cmH2O*second), compared with hPSV (18.5 (11.2; 22.5) cmH2O*second, P < 0.01). ABGs were no different between trials.

Conclusion

In comparison with hPSV and hNAVA, hNAVA15 significantly reduced EAdipeak and VASd, improving the pressurization and triggering performance, without affecting ABGs.

Authors’ Affiliations

(1)
Universita del Piemonte Orientale

References

  1. Cammarota G, et al.: Intensive Care Med. 2011, 37: 1943-1950. 10.1007/s00134-011-2382-2View ArticlePubMedGoogle Scholar

Copyright

© Longhini et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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