Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013, Paris, France.
Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
Intensive Care Med. 2016 Nov;42(11):1723-1732. doi: 10.1007/s00134-016-4447-8. Epub 2016 Sep 30.
Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that tailors the level of assistance delivered by the ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation.
A multicentre randomized controlled trial of 128 intubated adults recovering from acute respiratory failure was conducted in 11 intensive care units. Patients were randomly assigned to NAVA or PSV. The primary outcome was the probability of remaining in a partial ventilatory mode (either NAVA or PSV) throughout the first 48 h without any return to assist-control ventilation. Secondary outcomes included asynchrony index, ventilator-free days and mortality.
In the NAVA and PSV groups respectively, the proportion of patients remaining in partial ventilatory mode throughout the first 48 h was 67.2 vs. 63.3 % (P = 0.66), the asynchrony index was 14.7 vs. 26.7 % (P < 0.001), the ventilator-free days at day 7 were 1.0 day [1.0-4.0] vs. 0.0 days [0.0-1.0] (P < 0.01), the ventilator-free days at day 28 were 21 days [4-25] vs. 17 days [0-23] (P = 0.12), the day-28 mortality rate was 15.0 vs. 22.7 % (P = 0.21) and the rate of use of post-extubation noninvasive mechanical ventilation was 43.5 vs. 66.6 % (P < 0.01).
NAVA is safe and feasible over a prolonged period of time but does not increase the probability of remaining in a partial ventilatory mode. However, NAVA decreases patient-ventilator asynchrony and is associated with less frequent application of post-extubation noninvasive mechanical ventilation.
clinicaltrials.gov Identifier: NCT02018666.
神经调节辅助通气（NAVA）是一种根据膈肌肌电图活动来调整呼吸机辅助水平的通气模式。本研究的目的是比较 NAVA 和压力支持通气（PSV）在机械通气撤机早期的效果。
在 11 个重症监护病房进行了一项多中心、随机对照试验，纳入了 128 名因急性呼吸衰竭而插管的成年患者。患者被随机分配到 NAVA 或 PSV 组。主要结局是在最初 48 小时内，没有任何患者回到辅助控制通气，仍然保持部分通气模式（NAVA 或 PSV）的概率。次要结局包括人机不同步指数、无呼吸机天数和死亡率。
在 NAVA 和 PSV 组中，分别有 67.2%和 63.3%（P=0.66）的患者在最初 48 小时内保持部分通气模式，人机不同步指数分别为 14.7%和 26.7%（P<0.001），第 7 天无呼吸机天数分别为 1.0 天[1.0-4.0]和 0.0 天[0.0-1.0]（P<0.01），第 28 天无呼吸机天数分别为 21 天[4-25]和 17 天[0-23]（P=0.12），第 28 天死亡率分别为 15.0%和 22.7%（P=0.21），拔管后使用无创机械通气的比例分别为 43.5%和 66.6%（P<0.01）。
NAVA 是一种安全可行的通气方式，可以长时间使用，但并不能增加保持部分通气模式的概率。然而，NAVA 可减少人机不同步，与较少应用拔管后无创机械通气相关。
clinicaltrials.gov 标识符：NCT02018666。
