Université Paris 6-Pierre et Marie Curie, ER10, Paris, France.
Crit Care Med. 2012 Jun;40(6):1738-44. doi: 10.1097/CCM.0b013e3182451f77.
To compare the respective impact of pressure support ventilation and naturally adjusted ventilatory assist, with and without a noninvasive mechanical ventilation algorithm, on patient-ventilator interaction.
Prospective 2-month study.
Adult critical care unit in a tertiary university hospital.
Seventeen patients receiving a prophylactic postextubation noninvasive mechanical ventilation.
Patients were randomly mechanically ventilated for 10 mins with: pressure support ventilation without a noninvasive mechanical ventilation algorithm (PSV-NIV-), pressure support ventilation with a noninvasive mechanical ventilation algorithm (PSV-NIV+), neurally adjusted ventilatory assist without a noninvasive mechanical ventilation algorithm (NAVA-NIV-), and neurally adjusted ventilatory assist with a noninvasive mechanical ventilation algorithm (NAVA-NIV+).
Breathing pattern descriptors, diaphragm electrical activity, leak volume, inspiratory trigger delay, inspiratory time in excess, and the five main asynchronies were quantified. Asynchrony index and asynchrony index influenced by leaks were computed. Peak inspiratory pressure and diaphragm electrical activity were similar for each of the four experimental conditions. For both pressure support ventilation and neurally adjusted ventilatory assist, the noninvasive mechanical ventilation algorithm significantly reduced the level of leakage (p < .01). Inspiratory trigger delay was not affected by the noninvasive mechanical ventilation algorithm but was shorter in neurally adjusted ventilatory assist than in pressure support ventilation (p < .01). Inspiratory time in excess was shorter in neurally adjusted ventilatory assist and PSV-NIV+ than in PSV-NIV- (p < .05). Asynchrony index was not affected by the noninvasive mechanical ventilation algorithm but was significantly lower in neurally adjusted ventilatory assist than in pressure support ventilation (p < .05). Asynchrony index influenced by leaks was insignificant with neurally adjusted ventilatory assist and significantly lower than in pressure support ventilation (p < .05). There was more double triggering with neurally adjusted ventilatory assist.
Both neurally adjusted ventilatory assist and a noninvasive mechanical ventilation algorithm improve patient-ventilator synchrony in different manners. NAVA-NIV+ offers the best compromise between a good patient-ventilator synchrony and a low level of leaks. Clinical studies are required to assess the potential clinical benefit of neurally adjusted ventilatory assist in patients receiving noninvasive mechanical ventilation.
Clinicaltrials.gov Identifier NCT01280760.
比较压力支持通气和自然调节通气辅助，以及有无无创机械通气算法，对患者-呼吸机交互作用的影响。
前瞻性 2 个月研究。
成人重症监护病房，三级大学医院。
17 例预防性拔管后接受无创机械通气的患者。
患者随机接受 10 分钟机械通气：无无创机械通气算法的压力支持通气（PSV-NIV-）、有无创机械通气算法的压力支持通气（PSV-NIV+）、无无创机械通气算法的神经调节通气辅助（NAVA-NIV-）和有无创机械通气算法的神经调节通气辅助（NAVA-NIV+）。
量化了呼吸模式描述符、膈肌电活动、漏气量、吸气触发延迟、吸气时间过长和 5 种主要的不同步。计算了异步指数和受漏气影响的异步指数。在四种实验条件下，吸气峰压和膈肌电活动均相似。对于压力支持通气和神经调节通气辅助，无创机械通气算法都显著降低了漏气水平（p<0.01）。无创机械通气算法不影响吸气触发延迟，但神经调节通气辅助的吸气触发延迟比压力支持通气更短（p<0.01）。神经调节通气辅助和 PSV-NIV+的吸气时间过长比 PSV-NIV-更短（p<0.05）。无创机械通气算法不影响异步指数，但神经调节通气辅助的异步指数明显低于压力支持通气（p<0.05）。神经调节通气辅助受漏气影响的异步指数无显著性差异，明显低于压力支持通气（p<0.05）。神经调节通气辅助的双触发更多。
神经调节通气辅助和无创机械通气算法以不同的方式改善患者-呼吸机同步性。NAVA-NIV+在良好的患者-呼吸机同步性和低漏气水平之间提供了最佳的折衷。需要进行临床研究来评估神经调节通气辅助在接受无创机械通气的患者中的潜在临床益处。
Clinicaltrials.gov 标识符 NCT01280760。
