Baudin Florent, Pouyau Robin, Cour-Andlauer Fleur, Berthiller Julien, Robert Dominique, Javouhey Etienne
Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Bron, France.
Pediatr Pulmonol. 2015 Dec;50(12):1320-7. doi: 10.1002/ppul.23139. Epub 2014 Dec 8.
To determine the prevalence of main inspiratory asynchrony events during non-invasive intermittent positive-pressure ventilation (NIV) for severe bronchiolitis. Ventilator response time and asynchrony were compared in neurally adjusted ventilator assist (NAVA) and in pressure assist/control (PAC) modes.
This prospective physiological study was performed in a university hospital's paediatric intensive care unit and included 11 children (aged 35.2 ± 23 days) with respiratory syncytial virus bronchiolitis with failure of nCPAP. Patients received NIV for 2 hr in PAC mode followed by 2 hr in NAVA mode. Electrical activity of the diaphragm and pressure curves were recorded for 10 min. Trigger delay, main asynchronies (auto-triggering, double triggering, or non-triggered breaths) were analyzed, and the asynchrony index was calculated for each period.
The asynchrony index was lower during NAVA than during PAC (3 ± 3% vs. 38 ± 21%, P < 0.0001), and the trigger delay was shorter (43.9 ± 7.2 vs. 116.0 ± 38.9 ms, P < 0.0001). Ineffective efforts were significantly less frequent in NAVA mode (0.54 ± 1.5 vs. 21.8 ± 16.5 events/min, P = 0.01). Patient respiratory rates were similar, but the ventilator rate was higher in NAVA than in PAC mode (59.5 ± 17.9 vs. 49.8 ± 8.5/min, P = 0.03). The TcPCO2 baselines values (64 ± 12 mmHg vs. 62 ± 9 mmHg during NAVA, P = 0.30) were the same and their evolution over the 2 hr study period (-6 ± 10 mmHg vs. -12 ± 17 mmHg during NAVA, P = 0.36) did not differ.
Patient-ventilator inspiratory asynchronies and trigger delay were dramatically lower in NAVA mode than in PAC mode during NIV in infants with severe bronchiolitis.
确定在无创间歇正压通气（NIV）治疗重症细支气管炎期间主要吸气不同步事件的发生率。比较神经调节通气辅助（NAVA）模式和压力辅助/控制（PAC）模式下的呼吸机反应时间和不同步情况。
这项前瞻性生理学研究在一家大学医院的儿科重症监护病房进行，纳入了11名患有呼吸道合胞病毒细支气管炎且nCPAP治疗失败的儿童（年龄35.2±23天）。患者先在PAC模式下接受NIV治疗2小时，然后在NAVA模式下接受2小时治疗。记录膈肌电活动和压力曲线10分钟。分析触发延迟、主要不同步情况（自动触发、双重触发或无触发呼吸），并计算每个时间段的不同步指数。
NAVA模式下的不同步指数低于PAC模式（3±3%对38±21%，P<0.0001），触发延迟更短（43.9±7.2对116.0±38.9毫秒，P<0.0001）。NAVA模式下无效努力的频率显著更低（0.54±1.5对21.8±16.5次/分钟，P = 0.01）。患者呼吸频率相似，但NAVA模式下的呼吸机频率高于PAC模式（59.5±17.9对49.8±8.5次/分钟，P = 0.03）。TcPCO2基线值相同（NAVA期间为64±12mmHg对62±9mmHg，P = 0.30），且在2小时研究期间其变化（NAVA期间为-6±10mmHg对-12±17mmHg，P = 0.36）无差异。
在重症细支气管炎婴儿的NIV治疗中，NAVA模式下患者-呼吸机吸气不同步和触发延迟显著低于PAC模式。
