Division of Cardiology, Advocate Children's Hospital, Chicago Medical School/ Rosalind Franklin University of Medicine and Science, Chicago, Illinois.
Division of Critical Care, Texas Children's Hospital, Houston, Texas.
Pediatr Pulmonol. 2019 Sep;54(9):1374-1381. doi: 10.1002/ppul.24413. Epub 2019 Jun 24.
Neurally-adjusted ventilator assist (NAVA) is a relatively new form of ventilation in which the electrical activity of the diaphragm is sensed by a catheter. The amplitude of this electrical signal is then used to deliver an appropriately proportioned pressure supported breath to the patient. Due to the synchronous nature of the breaths and the patient-adjusted nature of the support, NAVA has been shown to have benefits over conventional ventilation. Meta-analyses were conducted of published pediatric studies to compare ventilatory endpoints between NAVA and conventional ventilation.
Studies comparing ventilatory parameters between NAVA and conventional ventilation in pediatric patients were identified. These studies were reviewed for appropriateness for inclusion and studies of only pediatric patients with data for similar endpoints between both arms were then pooled.
Statistically significant differences were noted in asynchrony, peak inspiratory pressure (PIP), and oxygen saturation by pulse oximetry. Asynchrony was 17% lower with NAVA, PIP was 1.74 cmH 0 lower with NAVA, and oxygen saturation was 1.1% greater with NAVA. There was no statistically significant difference in peak expiratory pressure, mean airway pressure, electrical diaphragmatic activity, respiratory rate, hydrogen ion concentration, partial pressure of oxygen, or partial pressure of carbon dioxide.
Statistically significant differences were noted in percent asynchrony, PIP, and oxygen saturation when comparing NAVA to conventional ventilation. These all tended to favor NAVA. Other than percent asynchrony, however, the other statistically significant findings were not clinically significant.
神经调节辅助通气（NAVA）是一种相对较新的通气方式，通过导管感知膈肌的电活动。然后，使用该电信号的幅度为患者提供适当比例的压力支持呼吸。由于呼吸的同步性和支持的患者调节性，NAVA 已被证明优于常规通气。对已发表的儿科研究进行了荟萃分析，以比较 NAVA 和常规通气之间的通气终点。
确定了比较儿科患者 NAVA 和常规通气之间通气参数的研究。对这些研究进行了适当性审查，并将仅包含儿科患者且两臂之间具有相似终点数据的研究进行了汇总。
在不同步、吸气峰压（PIP）和脉搏血氧饱和度方面均有统计学显著差异。NAVA 组的不同步率降低了 17%，PIP 降低了 1.74cmH2O，NAVA 组的血氧饱和度增加了 1.1%。呼气峰压、平均气道压、膈肌电活动、呼吸频率、氢离子浓度、氧分压或二氧化碳分压无统计学显著差异。
与常规通气相比，在比较 NAVA 时，百分比不同步、PIP 和氧饱和度均有统计学显著差异。这些都倾向于支持 NAVA。然而，除了百分比不同步外，其他统计学上显著的发现并不具有临床意义。
