Harnisch L O, Olgemoeller U, Mann J, Quintel M, Moerer O
Department of Anaesthesiology, University Medical Centre Göttingen, Germany Robert-Koch-Str. 40 D-37099 Göttingen.
Department of Cardiology and Pulmonology, University Medical Centre Göttingen, Robert-Koch-Str. 40 D-37099 Göttingen, Germany.
Pulm Med. 2020 Jun 20;2020:4705042. doi: 10.1155/2020/4705042. eCollection 2020.
Noninvasive neurally adjusted ventilatory assist (NAVA) has been shown to improve patient-ventilator interaction in many settings. There is still scarce data with regard to postoperative patients indicated for noninvasive ventilation (NIV) which this study elates. The purpose of this trial was to evaluate postoperative patients for synchrony and comfort in noninvasive pressure support ventilation (NIV-PSV) vs. NIV-NAVA.
Twenty-two subjects received either NIV-NAVA or NIV-PSV in an object-blind, prospective, randomized, crossover fashion (observational trial). We evaluated blood gases and ventilator tracings throughout as well as comfort of ventilation at the end of each ventilation phase.
There was an effective reduction in ventilator delays ( < 0.001) and negative pressure duration in NIV-NAVA as compared to NIV-PSV ( < 0.001). Although we used optimized settings in NIV-PSV, explaining the overall low incidence of asynchrony, NIV-NAVA led to reductions in the NeuroSync-index ( < 0.001) and all types of asynchrony except for double triggering that was significantly more frequent in NIV-NAVA vs. NIV-PSV ( = 0.02); ineffective efforts were reduced to zero by use of NIV-NAVA. In our population of previously lung-healthy subjects, we did not find differences in blood gases and patient comfort between the two modes.
In the postoperative setting, NIV-NAVA is well suitable for use and effective in reducing asynchronies as well as a surrogate for work of breathing. Although increased synchrony was not transferred into an increased comfort, there was an advantage with regard to patient-ventilator interaction. The trial was registered at the German clinical Trials Register (DRKS no.: DRKS00005408).
无创神经调节通气辅助（NAVA）已被证明在许多情况下可改善患者与呼吸机的相互作用。关于术后需要无创通气（NIV）的患者的数据仍然很少，本研究涉及这方面内容。本试验的目的是评估术后患者在无创压力支持通气（NIV-PSV）与NIV-NAVA中的同步性和舒适度。
22名受试者以客观盲法、前瞻性、随机、交叉方式（观察性试验）接受NIV-NAVA或NIV-PSV。我们在整个过程中评估血气和呼吸机波形，并在每个通气阶段结束时评估通气舒适度。
与NIV-PSV相比，NIV-NAVA的呼吸机延迟（<0.001）和负压持续时间有效降低（<0.001）。尽管我们在NIV-PSV中使用了优化设置，这解释了总体异步发生率较低的原因，但NIV-NAVA导致神经同步指数降低（<0.001），除双触发外的所有类型的异步均降低；双触发在NIV-NAVA中比NIV-PSV更频繁（=0.02）；通过使用NIV-NAVA，无效努力减少至零。在我们之前肺部健康的受试者群体中，我们未发现两种模式在血气和患者舒适度方面存在差异。
在术后环境中，NIV-NAVA非常适合使用，并且在减少异步以及作为呼吸功的替代指标方面有效。尽管同步性增加并未转化为舒适度增加，但在患者与呼吸机的相互作用方面存在优势。该试验已在德国临床试验注册中心注册（注册号：DRKS00005408）。
