通过头盔进行无创通气时神经调节通气辅助的新设置

New Setting of Neurally Adjusted Ventilatory Assist during Noninvasive Ventilation through a Helmet.

作者信息

Cammarota Gianmaria, Longhini Federico, Perucca Raffaella, Ronco Chiara, Colombo Davide, Messina Antonio, Vaschetto Rosanna, Navalesi Paolo

机构信息

From the Anesthesia and Intensive Care, "Maggiore della Carità" Hospital, Novara, Italy (G.C., R.P., D.C., A.M., R.V.); Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy (F.L., P.N.); Department of Translational Medicine, Eastern Piedmont University "A. Avogadro," Novara, Italy (C.R., P.N.); and CRRF Mons. L. Novarese, Moncrivello, Italy (P.N.).

出版信息

Anesthesiology. 2016 Dec;125(6):1181-1189. doi: 10.1097/ALN.0000000000001354.

DOI:10.1097/ALN.0000000000001354

PMID:27649505

Abstract

BACKGROUND

Compared to pneumatically controlled pressure support (PSP), neurally adjusted ventilatory assist (NAVA) was proved to improve patient-ventilator interactions, while not affecting comfort, diaphragm electrical activity (EAdi), and arterial blood gases (ABGs). This study compares neurally controlled pressure support (PSN) with PSP and NAVA, delivered through two different helmets, in hypoxemic patients receiving noninvasive ventilation for prevention of extubation failure.

METHODS

Fifteen patients underwent three (PSP, NAVA, and PSN) 30-min trials in random order with both helmets. Positive end-expiratory pressure was always set at 10 cm H2O. In PSP, the inspiratory support was set at 10 cm H2O above positive end-expiratory pressure. NAVA was adjusted to match peak EAdi (EAdipeak) during PSP. In PSN, the NAVA level was set at maximum matching the pressure delivered during PSP by limiting the upper pressure. The authors assessed patient comfort, EAdipeak, rates of pressurization (i.e., airway pressure-time product [PTP] of the first 300 and 500 ms after the initiation of patient effort, indexed to the ideal pressure-time products), and measured ABGs.

RESULTS

PSN significantly increased comfort to (median [25 to 75% interquartile range]) 8 [7 to 8] and 9 [8 to 9] with standard and new helmets, respectively, as opposed to both PSP (5 [5 to 6] and 7 [6 to 7]) and NAVA (6 [5 to 7] and 7 [6 to 8]; P < 0.01 for all comparisons). Regardless of the interface, PSN also decreased EAdipeak (P < 0.01), while increasing PTP of the first 300 ms from the onset of patient effort, indexed to the ideal PTP (P < 0.01) and PTP of the first 500 ms from the onset of patient effort, indexed to the ideal PTP (P < 0.001). ABGs were not different among trials.

CONCLUSIONS

When delivering noninvasive ventilation by helmet, compared to PSP and NAVA, PSN improves comfort and patient-ventilator interactions, while not ABGs. (Anesthesiology 2016; 125:1181-9).

摘要

背景

与气动控制压力支持（PSP）相比，神经调节通气辅助（NAVA）已被证明可改善患者与呼吸机的相互作用，同时不影响舒适度、膈肌电活动（EAdi）和动脉血气（ABG）。本研究比较了通过两种不同头盔进行无创通气以预防拔管失败的低氧血症患者中，神经控制压力支持（PSN）与PSP和NAVA的效果。

方法

15名患者使用两种头盔，以随机顺序进行三次（PSP、NAVA和PSN）30分钟的试验。呼气末正压始终设定为10 cm H₂O。在PSP中，吸气支持设定为比呼气末正压高10 cm H₂O。NAVA调整为与PSP期间的EAdi峰值（EAdipeak）相匹配。在PSN中，通过限制上限压力将NAVA水平设定为最大程度匹配PSP期间输送的压力。作者评估了患者舒适度、EAdipeak、增压速率（即患者开始用力后最初300和500毫秒的气道压力-时间乘积[PTP]，以理想压力-时间乘积为指数），并测量了ABG。

结果

与PSP（标准头盔时为5[5至6]，新头盔时为7[6至7]）和NAVA（分别为6[5至7]和7[6至8]；所有比较P<0.01）相比，PSN使用标准头盔和新头盔时分别显著提高了舒适度，中位数（四分位间距25%至75%）分别为8[7至8]和9[8至9]。无论使用何种接口，PSN还降低了EAdipeak（P<0.01），同时增加了患者开始用力后最初300毫秒的PTP（以理想PTP为指数，P<0.01）以及患者开始用力后最初500毫秒的PTP（以理想PTP为指数，P<0.001）。各试验间ABG无差异。