Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits

被引:81
作者
Beck, Jennifer
Campoccia, Francesca
Allo, Jean-Christophe
Brander, Lukas
Brunet, Fabrice
Slutsky, Arthur S.
Sinderby, Christer
机构
[1] Univ Toronto, Womens Coll Hosp, Sunnybrook Hlth Sci Ctr, Toronto, ON M5S 1B6, Canada
[2] Univ Toronto, Womens Coll Hosp, Dept Pediat, Toronto, ON M5S 1B6, Canada
[3] Univ Milan, Dept Surg Sci & Intens Care, San Gerardo Hosp, I-20052 Milan, Italy
[4] Hop Cochin, Serv Acceuil & Traitement Urgences, F-75679 Paris, France
[5] Univ Toronto, Dept Med, Toronto, ON M5B 1W8, Canada
[6] St Michaels Hosp, Dept Crit Care Med, Toronto, ON M5B 1W8, Canada
关键词
D O I
10.1203/01.pdr.0000257324.22406.93
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
With increasing pressure support ventilation (PSV), a form of pneumatically triggered ventilation, there can be an increase in wasted inspiratory efforts (neural inspiratory efforts that fail to trigger the ventilator). With neurally adjusted ventilatory assist (NAVA), a mode of ventilation controlled by the electrical activity of the diaphragm (EAdi), synchrony should be maintained at high levels of assist. The aim of this study was to evaluate the response to increasing levels of PSV and NAVA on synchrony and diaphragm unloading in lung-injured rabbits. Animals were ventilated on PSV or NAVA in random order, each at three levels. We measured neural and ventilator respiratory rates, EAdi, transdiaphragmatic pressure (Pdi), and tidal volume (VT). At low PSV, 95% of neural efforts were triggered. compared with high PSV, where only 66% of the neural efforts were triggered. During NAVA, all neural efforts were triggered, regardless of level. Increasing NAVA levels reduced EAdi and Pdi-time products by 48% (p < 0.05) and 66% (p < 0.05). In contrast, increasing PSV did not reduce the diaphragm electrical activity-time product and increased the transdiaphragmatic pressure-time product (p < 0.05) due to the increased wasted efforts. We conclude that synchrony with the ventilator is an important determinant for diaphragm unloading.
引用
收藏
页码:289 / 294
页数:6
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