Ducharme-Crevier Laurence, Beck Jennifer, Essouri Sandrine, Jouvet Philippe, Emeriaud Guillaume
Pediatric Intensive Care Unit, CHU Sainte-Justine, University of Montreal, 3175 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
Crit Care. 2015 Feb 17;19(1):44. doi: 10.1186/s13054-015-0770-7.
The need for intubation after a noninvasive ventilation (NIV) failure is frequent in the pediatric intensive care unit (PICU). One reason is patient-ventilator asynchrony during NIV. Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation controlled by the patient's neural respiratory drive. The aim of this study was to assess the feasibility and tolerance of NIV-NAVA in children and to evaluate its impact on synchrony and respiratory effort.
This prospective, physiologic, crossover study included 13 patients requiring NIV in the PICU of Sainte-Justine's Hospital from October 2011 to May 2013. Patients were successively ventilated in conventional NIV as prescribed by the physician in charge (30 minutes), in NIV-NAVA (60 minutes), and again in conventional NIV (30 minutes). Electrical activity of the diaphragm (EAdi) and airway pressure were simultaneously recorded to assess patient-ventilator synchrony.
NIV-NAVA was feasible and well tolerated in all patients. One patient asked to stop the study because of anxiety related to the leak-free facial mask. Inspiratory trigger dys-synchrony and cycling-off dys-synchrony were significantly shorter in NIV-NAVA versus initial and final conventional NIV periods (both P <0.05). Wasted efforts were also decreased in NIV-NAVA (all values expressed as median and interquartile values) (0 (0 to 0) versus 12% (4 to 20) and 6% (2 to 22), respectively; P <0.01). As a whole, total time spent in asynchrony was reduced to 8% (6 to 10) in NIV-NAVA, versus 27% (19 to 56) and 32% (21 to 38) in conventional NIV before and after NIV-NAVA, respectively (P =0.05).
NIV-NAVA is feasible and well tolerated in PICU patients and allows improved patient-ventilator synchronization. Larger controlled studies are warranted to evaluate the clinical impact of these findings.
ClinicalTrials.gov NCT02163382. Registered 9 June 2014.
在儿科重症监护病房（PICU），无创通气（NIV）失败后常需要进行气管插管。原因之一是NIV期间患者与呼吸机不同步。神经调节通气辅助（NAVA）是一种由患者神经呼吸驱动控制的通气模式。本研究的目的是评估儿童NIV-NAVA的可行性和耐受性，并评估其对同步性和呼吸功的影响。
这项前瞻性、生理学、交叉研究纳入了2011年10月至2013年5月在圣贾斯汀医院PICU需要NIV的13例患者。患者依次接受主管医生规定的常规NIV通气（30分钟）、NIV-NAVA通气（60分钟），然后再次接受常规NIV通气（30分钟）。同时记录膈肌电活动（EAdi）和气道压力，以评估患者与呼吸机的同步性。
NIV-NAVA在所有患者中都是可行的且耐受性良好。1例患者因与无泄漏面罩相关的焦虑要求停止研究。与初始和最终常规NIV阶段相比，NIV-NAVA期间吸气触发不同步和脱机不同步明显缩短（均P<0.05）。NIV-NAVA期间无效功也减少（所有值均表示为中位数和四分位数间距）（分别为0（0至0）与12%（4至20）和6%（2至22）；P<0.01）。总体而言，NIV-NAVA期间不同步的总时间减少至8%（6至10），而NIV-NAVA之前和之后常规NIV期间分别为27%（19至56）和32%（21至38）（P=0.05）。
NIV-NAVA在PICU患者中是可行的且耐受性良好，并能改善患者与呼吸机的同步性。需要进行更大规模的对照研究来评估这些发现的临床影响。
ClinicalTrials.gov NCT02163382。2014年6月9日注册。
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