Navalesi Paolo, Longhini Federico
aAnesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli bDepartment of Translational Medicine, Eastern Piedmont University 'A. Avogadro', Novara cCRRF Mons. L. Novarese, Moncrivello, Vercelli, Italy.
Curr Opin Crit Care. 2015 Feb;21(1):58-64. doi: 10.1097/MCC.0000000000000167.
Compared with the conventional forms of partial support, neurally adjusted ventilatory assist was repeatedly shown to improve patient-ventilator synchrony and reduce the risk of overassistance, while guaranteeing adequate inspiratory effort and gas exchange. A few animal studies also suggested the potential of neurally adjusted ventilatory assist in averting the risk of ventilator-induced lung injury. Recent work adds new information on the physiological effects of neurally adjusted ventilatory assist.
Compared with pressure support, neurally adjusted ventilatory assist has been shown to improve patient-ventilator interaction and synchrony in patients with the most challenging respiratory system mechanics, such as very low compliance consequent to severe acute respiratory distress syndrome and high resistance and air trapping due to chronic airflow obstruction; enhance redistribution of the ventilation in the dependent lung regions; avert the risk of patient-ventilator asynchrony due to sedation; avoid central apneas; limit the risk of high (injurious) tidal volumes in patients with acute respiratory distress syndrome of varied severity; and improve patient-ventilator interaction and synchrony during noninvasive ventilation, irrespective of the interface utilized.
Several studies nowadays prove the physiological benefits of neurally adjusted ventilatory assist, as opposed to the conventional modes of partial support. Whether these advantages translate into improvement of clinical outcomes remains to be determined.
与传统的部分支持形式相比，神经调节通气辅助已多次显示可改善患者与呼吸机的同步性并降低过度辅助的风险，同时保证足够的吸气努力和气体交换。一些动物研究还表明神经调节通气辅助在避免呼吸机诱导的肺损伤风险方面具有潜力。近期的研究为神经调节通气辅助的生理效应增添了新信息。
与压力支持相比，神经调节通气辅助已被证明可改善呼吸系统力学最具挑战性的患者的患者-呼吸机相互作用和同步性，例如因严重急性呼吸窘迫综合征导致的极低顺应性以及因慢性气流阻塞导致的高阻力和气体陷闭；增强依赖肺区的通气再分布；避免因镇静导致的患者-呼吸机不同步风险；避免中枢性呼吸暂停；限制不同严重程度急性呼吸窘迫综合征患者出现高（损伤性）潮气量的风险；并且无论使用何种接口，均可改善无创通气期间的患者-呼吸机相互作用和同步性。
如今多项研究证明了神经调节通气辅助相对于传统部分支持模式的生理益处。这些优势是否能转化为临床结局的改善仍有待确定。
