Early Noninvasive Neurally Adjusted Ventilatory Assist Versus Noninvasive Flow-Triggered Pressure Support Ventilation in Pediatric Acute Respiratory Failure: A Physiologic Randomized Controlled Trial.

Abstract

OBJECTIVE:

Neurally adjusted ventilatory assist has been shown to improve patient-ventilator interaction in children with acute respiratory failure. Objective of this study was to compare the effect of noninvasive neurally adjusted ventilatory assist versus noninvasive flow-triggered pressure support on patient-ventilator interaction in children with acute respiratory failure, when delivered as a first-line respiratory support.

DESIGN:

Prospective randomized crossover physiologic study.

SETTING:

Pediatric six-bed third-level PICU.

PATIENTS:

Eighteen children with acute respiratory failure needing noninvasive ventilation were enrolled at PICU admission.

INTERVENTIONS:

Enrolled children were allocated to receive two 60-minutes noninvasive flow-triggered pressure support and noninvasive neurally adjusted ventilatory assist trials in a crossover randomized sequence.

MEASUREMENTS AND MAIN RESULTS:

Primary endpoint was the asynchrony index. Parameters describing patient-ventilator interaction and gas exchange were also considered as secondary endpoints. Noninvasive neurally adjusted ventilatory assist compared to noninvasive flow-triggered pressure support: 1) reduced asynchrony index (p = 0.001) and the number of asynchronies per minute for each type of asynchrony; 2) it increased the neuroventilatory efficiency index (p = 0.001), suggesting better neuroventilatory coupling; 3) reduced inspiratory and expiratory delay times (p = 0.001) as well as lower peak and mean airway pressure (p = 0.006 and p = 0.038, respectively); 4) lowered oxygenation index (p = 0.043). No adverse event was reported.

CONCLUSIONS:

In children with mild early acute respiratory failure, noninvasive neurally adjusted ventilatory assist was feasible and safe. Noninvasive neurally adjusted ventilatory assist compared to noninvasive flow-triggered pressure support improved patient-ventilator interaction.

• Authors: Giovanna Chidini, Daniele De Luca, Giorgio Conti, Paolo Pelosi, Stefano Nava, Edoardo Calderini
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 17 Issue 11 Pg. e487-e495 (11 2016) ISSN: 1529-7535 [Print] United States
• PMID: 27749511 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Topics

• Acute Disease
• Child, Preschool
• Critical Care (methods)
• Cross-Over Studies
• Female
• Humans
• Infant
• Intensive Care Units, Pediatric
• Interactive Ventilatory Support (methods)
• Male
• Positive-Pressure Respiration (methods)
• Prospective Studies
• Respiratory Insufficiency (physiopathology, therapy)
• Treatment Outcome