Lee Juyoung, Kim Han-Suk, Jung Young Hwa, Choi Chang Won, Jun Yong Hoon
Department of Pediatrics, Inha University College of Medicine, Incheon, Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Pediatr Int. 2017 May;59(5):540-544. doi: 10.1111/ped.13233. Epub 2017 Mar 21.
Severe bronchopulmonary dysplasia often leads to prolonged mechanical ventilation lasting several months. Cyanotic episodes frequently occur in these patients, necessitating long-term sedation and/or intermittent muscle paralysis. Neurally adjusted ventilatory assist (NAVA) might provide precisely the amount of support that these patients need without sedation.
We reviewed the medical records of preterm infants who underwent tracheostomy and required mechanical ventilation for >6 months during a period of 6 years. We compared two groups of patients: those supported with NAVA for ≥2 months versus those supported by pneumatically triggered assist methods. We also evaluated any change after NAVA use in the NAVA group.
Among 14 prematurely born patients who received prolonged ventilation, nine were supported with NAVA and five were supported using other ventilator modes. Duration of continuous sedation was significantly shorter and the bolus use of sedatives was also significantly lower in the NAVA group than in the pneumatically triggered assist group. In addition, the NAVA group received a lower dose of dexamethasone than the pneumatically triggered assist group. Compared with before NAVA, the frequency of cyanotic episodes and of the bolus sedatives was significantly decreased after implementation of NAVA.
For infants on prolonged mechanical ventilation, NAVA could reduce cyanotic episodes and the need for sedatives and dexamethasone. NAVA may be superior to pneumatically triggered modes in terms of the minimization of patient-ventilator dyssynchrony while delivering appropriate respiratory support in premature infants with tracheostomy.
严重支气管肺发育不良常导致机械通气时间延长数月。这些患者经常发生发绀发作，需要长期镇静和/或间歇性肌肉麻痹。神经调节通气辅助（NAVA）可能恰好能为这些患者提供所需的支持量而无需镇静。
我们回顾了6年间接受气管切开术且机械通气时间超过6个月的早产儿的病历。我们比较了两组患者：接受NAVA支持≥2个月的患者与接受气动触发辅助方法支持的患者。我们还评估了NAVA组使用NAVA后的任何变化。
在14例接受长时间通气的早产患者中，9例接受NAVA支持，5例使用其他通气模式支持。NAVA组的持续镇静时间明显更短，镇静剂的大剂量使用也明显低于气动触发辅助组。此外，NAVA组接受的地塞米松剂量低于气动触发辅助组。与使用NAVA前相比，实施NAVA后发绀发作频率和大剂量镇静剂使用明显减少。
对于长时间机械通气的婴儿，NAVA可减少发绀发作以及对镇静剂和地塞米松的需求。在最小化患者 - 呼吸机不同步方面，NAVA在为气管切开术的早产儿提供适当呼吸支持时可能优于气动触发模式。
