Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.
INSERM, CNRS ERL 7000, IMRB, Université Paris Est Creteil, Créteil, France.
Neonatology. 2022;119(3):386-393. doi: 10.1159/000524327. Epub 2022 May 3.
Synchronization of non-invasive ventilation is challenging in extremely premature infants. We compared patient-ventilator synchrony between non-invasive neurally adjusted ventilatory assist (NIV-NAVA) using transdiaphragmatic (Edi) catheter and synchronized intermittent positive airway pressure (SiPAP) using an abdominal trigger.
This study was a monocentric, randomized, crossover trial in premature infants born before 28 weeks of gestation, aged 3 days or more, and below 32 weeks postmenstrual age. NIV-NAVA and SiPAP were applied in a random order for 2 h with analysis of data from the second hour. The primary outcome was the asynchrony index.
Fourteen patients were included (median [IQR] gestational age at birth 25.6 (25.3-26.4) weeks, median [IQR] birth weight 755 [680-824] g, median [IQR] postnatal age 26.5 [19.8-33.8] days). The median (IQR) asynchrony index was significantly lower in NIV-NAVA versus SiPAP (49.9% [44.1-52.6] vs. 85.8% [74.2-90.9], p < 0.001). Ineffective efforts and auto-triggering were significantly less frequent in NIV-NAVA versus SiPAP (3.0% vs. 32.0% p < 0.001 and 10.0% vs. 26.6%, p = 0.004, respectively). Double triggering was significantly less frequent in SiPAP versus NIV-NAVA (0.0% vs. 9.0%, p < 0.001). No significant difference was observed for premature cycling and late cycling. Peak Edi and swing Edi were significantly lower in NIV-NAVA as compared to SiPAP (7.7 [6.1-9.9] vs. 11.0 [6.7-14.5] μV, p = 0.006; 5.4 [4.2-7.6] vs. 7.6 [4.3-10.8] μV, p = 0.007, respectively). No significant difference was observed between NIV-NAVA and SiPAP for heart rate, respiratory rate, COMFORTneo scores, apnoea, desaturations, or bradycardias.
DISCUSSION/CONCLUSION: NIV-NAVA markedly improves patient-ventilator synchrony as compared to SiPAP in extremely premature infants.
在极早产儿中，无创通气的同步性具有挑战性。我们比较了经膈肌（Edi）导管的神经调节辅助无创通气（NIV-NAVA）和腹部触发的同步间歇正压通气（SiPAP）之间的患者-呼吸机同步性。
这是一项单中心、随机、交叉试验，纳入了胎龄 28 周以下、3 天或以上、孕龄 32 周以下的早产儿。以随机顺序应用 NIV-NAVA 和 SiPAP 各 2 小时，分析第 2 小时的数据。主要结局是失同步指数。
共纳入 14 名患者（中位[IQR]出生时胎龄 25.6[25.3-26.4]周，中位[IQR]出生体重 755[680-824]g，中位[IQR]生后年龄 26.5[19.8-33.8]天）。与 SiPAP 相比，NIV-NAVA 的失同步指数明显更低（49.9%[44.1-52.6] vs. 85.8%[74.2-90.9]，p<0.001）。与 SiPAP 相比，NIV-NAVA 中无效努力和自动触发的频率明显更低（3.0% vs. 32.0%，p<0.001 和 10.0% vs. 26.6%，p=0.004）。SiPAP 中双触发的频率明显低于 NIV-NAVA（0.0% vs. 9.0%，p<0.001）。在过早触发和延迟触发方面，NIV-NAVA 与 SiPAP 之间无显著差异。与 SiPAP 相比，NIV-NAVA 的峰值 Edi 和摆动 Edi 明显更低（7.7[6.1-9.9] vs. 11.0[6.7-14.5]μV，p=0.006；5.4[4.2-7.6] vs. 7.6[4.3-10.8]μV，p=0.007）。与 SiPAP 相比，NIV-NAVA 对心率、呼吸频率、舒适评分、呼吸暂停、低氧血症或心动过缓无显著影响。
讨论/结论：与 SiPAP 相比，NIV-NAVA 可显著改善极早产儿的患者-呼吸机同步性。
