Unité de Réanimation Pédiatrique, Hôpital Mère-Enfant Faïencerie, CHU de Nantes, 38 Boulevard Jean-Monnet, 44093 Nantes, France.
BMC Pediatr. 2011 Oct 20;11:92. doi: 10.1186/1471-2431-11-92.
Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation controlled by diaphragmatic electrical signals. The electrical signals allow synchronization of ventilation to spontaneous breathing efforts of a child, as well as permitting pressure assistance proportional to the electrical signal. NAVA provides equally fine synchronization of respiratory support and pressure assistance varying with the needs of the child. NAVA has mainly been studied in children who underwent cardiac surgery during the period of weaning from a respirator.
We report here a series of 3 children (1 month, 3 years, and 28 days old) with severe respiratory distress due to RSV-related bronchiolitis requiring invasive mechanical ventilation with a high level of oxygen (FiO2 ≥ 50%) for whom NAVA facilitated respiratory support. One of these children had diagnosis criteria for acute lung injury, another for acute respiratory distress syndrome.Establishment of NAVA provided synchronization of mechanical ventilatory support with the breathing efforts of the children. Respiratory rate and inspiratory pressure became extremely variable, varying at each cycle, while children were breathing easily and smoothly. All three children demonstrated less oxygen requirements after introducing NAVA (57 ± 6% to 42 ± 18%). This improvement was observed while peak airway pressure decreased (28 ± 3 to 15 ± 5 cm H2O). In one child, NAVA facilitated the management of acute respiratory distress syndrome with extensive subcutaneous emphysema.
Our findings highlight the feasibility and benefit of NAVA in children with severe RSV-related bronchiolitis. NAVA provides a less aggressive ventilation requiring lower inspiratory pressures with good results for oxygenation and more comfort for the children.
神经调节辅助通气（NAVA）是一种新的机械通气模式，由膈肌电信号控制。电信号允许通气与儿童自主呼吸努力同步，并且允许压力辅助与电信号成比例。NAVA 提供了同样精细的呼吸支持同步和压力辅助，根据儿童的需求而变化。NAVA 主要在接受心脏手术的儿童中进行研究，这些儿童在从呼吸机脱机期间需要接受机械通气。
我们在此报告了 3 例患有严重呼吸窘迫的儿童（1 个月、3 岁和 28 天），他们因 RSV 相关细支气管炎而需要接受高浓度氧气（FiO2≥50%）的有创机械通气，这些儿童需要使用 NAVA 来辅助呼吸支持。这些儿童中有 1 例符合急性肺损伤的诊断标准，另 1 例符合急性呼吸窘迫综合征的诊断标准。NAVA 的建立提供了机械通气支持与儿童呼吸努力的同步。呼吸频率和吸气压力变得非常不稳定，每个周期都在变化，而儿童呼吸轻松顺畅。所有 3 例儿童在引入 NAVA 后氧气需求减少（57±6%至 42±18%）。在降低气道峰压（28±3 至 15±5cmH2O）的同时观察到了这一改善。在 1 例儿童中，NAVA 有助于管理伴有广泛皮下气肿的急性呼吸窘迫综合征。
我们的研究结果强调了 NAVA 在严重 RSV 相关细支气管炎儿童中的可行性和益处。NAVA 提供了一种侵袭性较小的通气方式，需要较低的吸气压力，同时具有良好的氧合效果和儿童舒适度。
