Section of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Section of Neonatology, Arkansas Children's Hospital, Little Rock, Arkansas.
Respir Care. 2018 Dec;63(12):1478-1484. doi: 10.4187/respcare.06192. Epub 2018 Sep 25.
Noninvasive ventilation (NIV) is commonly used in neonates. A mode of NIV called neurally adjusted ventilatory assist (NAVA) offers patient-ventilator interactions by using electrical activity of the diaphragm to control mechanical breaths. We hypothesized that the work of breathing (WOB) would decrease with NIV-NAVA. Secondary objectives evaluated the impact of NIV-NAVA on arterial blood gases and respiratory parameters.
We compared WOB between synchronized breaths in NIV-NAVA and NIV in piglets with healthy lungs and then with surfactant-depleted lungs. Neonatal pigs (median, 2.0 [range, 1.8-2.4] kg) with healthy and then surfactant depleted lungs were sedated and ventilated with NIV-NAVA and NIV in random order. Airway flow and pressure waveforms were acquired. Waveforms were analyzed for the pressure-time product that reflected WOB. The primary outcome between modes was assessed with repeated measurement analysis of variance.
The pressure-time product was significantly decreased for NIV-NAVA in both healthy and injured lungs ( < .001). P , P , inspiratory tidal volume, and peak inspiratory flow were not different in either model.
Synchronized breaths during NIV-NAVA resulted in decreased WOB compared with synchronized breaths during NIV.
无创通气（NIV）常用于新生儿。一种称为神经调节通气辅助（NAVA）的 NIV 模式通过使用膈肌的电活动来控制机械呼吸，从而实现患者与呼吸机的交互作用。我们假设 NAVA 会降低呼吸功（WOB）。次要目标评估了 NAVA 对动脉血气和呼吸参数的影响。
我们比较了健康肺和表面活性剂耗竭肺的猪在 NAVA 和 NIV 中的同步呼吸之间的 WOB。健康和表面活性剂耗竭的新生猪（中位数，2.0[范围，1.8-2.4]kg）被镇静并用 NAVA 和 NIV 随机顺序通气。获取气道流量和压力波形。对反映 WOB 的压力时间乘积进行波形分析。使用重复测量方差分析评估模式之间的主要结果。
健康和受伤肺的 NAVA 中压力时间乘积均显著降低（<.001）。两种模型的 P, P, 吸气潮气量和吸气峰流速均无差异。
与 NIV 中的同步呼吸相比，NAVA 期间的同步呼吸导致 WOB 降低。
