Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: Nested study

Objective

Neurally adjusted ventilatory assist (NAVA) is a new ventilator modality with an innovative synchronization technique. Our aim is to verify if NAVA is feasible and safe in terms of physiological and clinical variables in infants recovering from severe acute respiratory distress syndrome (ARDS).

Design

This is a pilot nested study to help future trial design.

Setting

The study was performed in third-level academic pediatric intensive care units.

Patients

Infants affected by severe ARDS requiring high-frequency ventilation and weaned with NAVA during 2010 were included. Controls (2:1 ratio) were ARDS infants weaned with pressure support ventilation (PSV) during 2008-2009 matched for age, gas exchange impairment, and weight.

Main outcome measures

The main outcome measures were the physiological and ventilator parameters and the duration of ventilator support in PSV or NAVA.

Results

Ten infants treated with NAVA and 20 with PSV were studied. Heart rate (P < .001) and mean arterial pressure (P < .001) increased less during NAVA than during PSV. Similarly, Pao₂/Fio₂ ratio decreased less in NAVA than in PSV (P < .001). Neurally adjusted ventilatory assist also resulted in lower Paco₂ (P < .001) and peak pressure (P = .001), as well as higher minute ventilation (P = .013). COMFORT score (P = .004) and duration of support were lower in NAVA than in PSV (P = .011).

Conclusions

Neurally adjusted ventilatory assist is safe and suitable in infants recovering from severe ARDS. It could provide better results than PSV and is worth to be investigated in a multicenter randomized trial.