Anesthesia and General Intensive Care, "Maggiore Della Carità" University Hospital, Novara, Italy.
Department of Medicine and Surgery, Università Degli Studi Di Perugia, Perugia, Italy.
J Clin Monit Comput. 2022 Apr;36(2):419-427. doi: 10.1007/s10877-021-00668-2. Epub 2021 Feb 9.
Driving pressure can be readily measured during assisted modes of ventilation such as pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). The present prospective randomized crossover study aimed to assess the changes in driving pressure in response to variations in the level of assistance delivered by PSV vs NAVA.
16 intubated adult patients, recovering from hypoxemic acute respiratory failure (ARF) and undergoing assisted ventilation, were randomly subjected to six 30-min-lasting trials. At baseline, PSV (PSV100) was set with the same regulation present at patient enrollment. The corresponding level of NAVA (NAVA100) was set to match the same inspiratory peak of airway pressure obtained in PSV100. Therefore, the level of assistance was reduced and increased by 50% in both ventilatory modes (PSV50, NAVA50; PSV150, NAVA150). At the end of each trial, driving pressure obtained in response to four short (2-3 s) end-expiratory and end-inspiratory occlusions was analyzed.
Driving pressure at PSV50 (6.6 [6.1-7.8] cmHO) was lower than that recorded at PSV100 (7.9 [7.2-9.1] cmHO, P = 0.005) and PSV150 (9.9 [9.1-13.2] cmHO, P < 0.0001). In NAVA, driving pressure at NAVA50 was reduced compared to NAVA150 (7.7 [5.1-8.1] cmHO vs 8.3 [6.4-11.4] cmHO, P = 0.013), whereas there were no changes between baseline and NAVA150 (8.5 [6.3-9.8] cmHO vs 8.3 [6.4-11.4] cmHO, P = 0.331, respectively). Driving pressure at PSV150 was higher than that observed in NAVA150 (P = 0.011).
NAVA delivers better lung-protective ventilation compared to PSV in hypoxemic ARF patients.
The present trial was prospectively registered at www.clinicatrials.gov (NCT03719365) on 24 October 2018.
在压力支持通气（PSV）和神经调节辅助通气（NAVA）等辅助通气模式下，可直接测量驱动压。本前瞻性随机交叉研究旨在评估 PSV 与 NAVA 所提供的辅助水平变化时驱动压的变化。
16 例接受插管的成人患者，从低氧性急性呼吸衰竭（ARF）中恢复并接受辅助通气，随机接受 6 次持续 30 分钟的试验。在基线时，以患者入组时的相同调节设置 PSV（PSV100）。相应的 NAVA（NAVA100）水平设置为与 PSV100 中获得的相同气道峰压相匹配。因此，两种通气模式（PSV50、NAVA50；PSV150、NAVA150）的辅助水平降低和增加了 50%。在每个试验结束时，分析了 4 次短暂（2-3 秒）呼气末和吸气末闭塞时驱动压。
PSV50 时的驱动压（6.6 [6.1-7.8] cmHO）低于 PSV100 时的驱动压（7.9 [7.2-9.1] cmHO，P = 0.005）和 PSV150 时的驱动压（9.9 [9.1-13.2] cmHO，P < 0.0001）。在 NAVA 中，NAVA50 时的驱动压低于 NAVA150 时的驱动压（7.7 [5.1-8.1] cmHO 比 8.3 [6.4-11.4] cmHO，P = 0.013），而 NAVA150 与 NAVA150 之间没有变化（8.5 [6.3-9.8] cmHO 比 8.3 [6.4-11.4] cmHO，P = 0.331）。PSV150 时的驱动压高于 NAVA150 时的驱动压（P = 0.011）。
与 PSV 相比，NAVA 为低氧性 ARF 患者提供了更好的肺保护通气。
本试验于 2018 年 10 月 24 日在 www.clinicatrials.gov（NCT03719365）前瞻性注册。
