Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, People's Republic of China.
Respir Care. 2022 Jul;67(7):879-888. doi: 10.4187/respcare.09881. Epub 2022 Feb 17.
Noninvasive ventilation (NIV) is increasingly used during ventilatory support. Neurally-adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that can improve patient-ventilator interaction. We conducted a meta-analysis to compare patient-ventilator interaction and clinical outcomes between NAVA and pressure support ventilation (PSV) in adult subjects during NIV.
The PubMed, Cochrane Library, Web of Science, OpenGrey, and Embase databases were searched for appropriate clinical trials comparing NIV-NAVA with NIV-PSV for adult subjects. Comparisons of asynchrony index (AI), types of asynchrony, and clinical outcomes were pooled.
Fifteen studies were included involving 615 subjects. AI was significantly lower in NAVA than PSV group (mean difference [MD] -14.70 [95% CI -23.20 to -6.19], < .001). Subgroup analysis grouped by exacerbation of COPD or non-COPD showed that the AI of NAVA was lower than PSV in COPD exacerbation (MD -14.56 [95% CI -21.04 to -8.09], < .001) and non-COPD (MD -3.02 [95% CI -4.44 to -1.61], < .001). Severe asynchrony was significantly lower in NAVA than in PSV (odds ratio 0.06 [95% CI 0.03-0.11], < .001). Inspiratory trigger delay in NAVA was significantly lower than PSV (MD -129.60 [95% CI -148.43 to -110.78], < .001). NAVA had longer ICU length of stay than PSV (MD 1.22 [95% CI 0.44-2.00], = .002). Level of discomfort was significantly higher in NAVA group than PSV group (MD 0.62 [95% CI 0.02-1.21], = .040).
NAVA has advantages in ventilator-patient interaction compared to PSV in NIV. Further research is needed in order to estimate effects on clinical outcomes.
无创通气（NIV）在通气支持中越来越多地使用。神经调节辅助通气（NAVA）是一种机械通气模式，可以改善患者与呼吸机的相互作用。我们进行了一项荟萃分析，比较了成人 NIV 期间 NAVA 与压力支持通气（PSV）的患者-呼吸机相互作用和临床结局。
检索 PubMed、Cochrane 图书馆、Web of Science、OpenGrey 和 Embase 数据库，以寻找比较成人 NIV-NAVA 与 NIV-PSV 的临床试验。汇总了异步指数（AI）、异步类型和临床结局的比较。
纳入了 15 项研究，涉及 615 名受试者。NAVA 组的 AI 明显低于 PSV 组（平均差异[MD] -14.70 [95%置信区间-23.20 至-6.19]，<0.001）。根据 COPD 加重或非 COPD 分组的亚组分析显示，在 COPD 加重（MD-14.56 [95%置信区间-21.04 至-8.09]，<0.001）和非 COPD（MD-3.02 [95%置信区间-4.44 至-1.61]，<0.001）中，NAVA 的 AI 低于 PSV。NAVA 组严重异步的发生率明显低于 PSV 组（比值比 0.06 [95%置信区间 0.03-0.11]，<0.001）。NAVA 的吸气触发延迟明显低于 PSV（MD-129.60 [95%置信区间-148.43 至-110.78]，<0.001）。NAVA 的 ICU 住院时间长于 PSV（MD 1.22 [95%置信区间 0.44-2.00]，=0.002）。NAVA 组的不适感明显高于 PSV 组（MD 0.62 [95%置信区间 0.02-1.21]，=0.040）。
与 NIV 中的 PSV 相比，NAVA 在患者与呼吸机的相互作用方面具有优势。需要进一步研究以评估对临床结局的影响。
Zotero 插件