Department of Pulmonary, Critical Care, and Sleep Medicine; Dr Khan is affiliated with the Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Respir Care. 2020 Jan;65(1):53-61. doi: 10.4187/respcare.07122. Epub 2019 Oct 22.
This study was conducted to compare the effectiveness of noninvasive ventilation (NIV) with pressure support (NIV-PSV) to noninvasive neurally-adjusted ventilatory assist (NIV-NAVA) during COPD exacerbation.
In this study, 40 subjects with COPD and acute hypercapnic respiratory failure were randomized to receive either NIV-NAVA ( = 20) or NIV-PSV ( = 20) via a critical care ventilator. Subjects' vital parameters, arterial blood gas values, patient-ventilator asynchrony events, and asynchrony index were noted at specific time intervals in both groups. The duration of NIV, rate of NIV failure, and length hospital stay were also recorded for these 2 modes of NIV.
NIV-NAVA significantly reduced the total number (median [interquartile range]) of asynchrony events compared to NIV-PSV: 22 (15-32.5) versus 65 (50.75-104.25), respectively, = .002. Severe asynchrony defined as asynchrony index > 10% was also significantly lower in NIV-NAVA than in NIV-PSV ( < .001). There was no significant difference between the 2 groups regarding improvement in gas exchange and vital parameters. Rate of failure of NIV ( = .73), duration of the requirement of ventilatory support ( = .40), and hospital length of stay ( = .46) were also comparable between the 2 modes of ventilation.
Compared to NIV-PSV, NIV-NAVA was associated with better patient-ventilator synchrony and a reduction in the number of asynchrony events in subjects with an exacerbation of COPD, with similar effects on improvement in gas exchange, duration of NIV, hospital lenght of stay, and rate of NIV failure. (Clinicaltrials.gov registration NCT02912689.).
本研究旨在比较无创通气（NIV）与压力支持（NIV-PSV）和无创神经调节通气辅助（NIV-NAVA）在 COPD 加重期的疗效。
本研究中，40 例 COPD 合并急性高碳酸血症呼吸衰竭患者随机分为 NIV-NAVA 组（ = 20 例）和 NIV-PSV 组（ = 20 例），通过重症监护呼吸机进行治疗。记录两组患者生命体征、动脉血气值、人机不同步事件和不同步指数，同时记录两种 NIV 模式的 NIV 时间、NIV 失败率和住院时间。
与 NIV-PSV 相比，NIV-NAVA 可显著减少总不同步事件数（中位数[四分位间距]）：分别为 22（15-32.5）和 65（50.75-104.25）， =.002。严重不同步定义为不同步指数>10%，NIV-NAVA 组也明显低于 NIV-PSV 组（ <.001）。两组患者在改善气体交换和生命体征方面无显著差异。NIV 失败率（ =.73）、呼吸机支持需求时间（ =.40）和住院时间（ =.46）在两种通气模式之间也相似。
与 NIV-PSV 相比，NIV-NAVA 可改善 COPD 加重期患者的人机同步性，减少不同步事件的发生，改善气体交换、NIV 时间、住院时间和 NIV 失败率的效果相似。（Clinicaltrials.gov 注册号：NCT02912689）。
