Conseil Matthieu, Jaber Samir, Galia Fabrice, Molinari Nicolas, Chanques Gerald, De Jong Audrey, Capdevila Mathieu
Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, 80 avenue Augustin Fliche, Montpellier, 34295, France.
INSERM U1046 PhyMedExp, Montpellier, France.
Ann Intensive Care. 2025 Aug 29;15(1):128. doi: 10.1186/s13613-025-01552-x.
Neurally Adjusted Ventilatory Assist (NAVA) compared to Pressure Support Ventilation (PSV) improves patient-ventilator interactions in intensive care unit. No study has evaluated NAVA in patients with obesity. We aimed to assess the feasibility and safety of NAVA in patients with obesity, and to compare NAVA in patients with versus without obesity.
In this randomized cross-over study, all respiratory cycles during 1 h of mechanical ventilation from 10 patients with obesity and 11 without obesity were analyzed. Patients underwent 30 min of NAVA and 30 min of PSV in a random order. Flow, airway pressure and diaphragm electrical activity were continuously recorded. Arterial blood gases were obtained at baseline and at the end of each 30-min period. Patient-ventilator interactions were assessed with trigger delay, inspiratory time in excess, rate and type of dyssynchrony cycles. Variability of the ventilatory parameters was evaluated by the coefficient of variation (SD/mean).
All patients concluded the study, with a total of 1790 ± 873 respiratory cycles analyzed per patient. In patients with obesity, NAVA versus PSV was associated with a significant reduction in trigger delay (0 [0-5] vs. 106 [34-125] ms, p < 0.05), inspiratory time in excess (96 [94-102] vs. 145 [137-202] ms, p < 0.01) and in ineffective efforts (0 [0-0.03] vs. 0.33 [0.23-0.37] events/min, p < 0.05). The global dyssynchrony index remained similar in both modes (2.2% [1.1-4.4] vs. 3.7% [2.4-5.6], p = 0.68). Compared to PSV, PaO2/FiO2 ratio significantly increased in NAVA, 238 mmHg [174-344] versus 207 mmHg [164-297], p < 0.05. The tidal volume was significantly lower during NAVA than during PSV, 6.7 mL/kg predicted body weight [5.9-7.1] versus 7.2 mL/kg [6.2-8.2], p < 0.05. Ventilatory variability was significantly higher with NAVA, 16% [11-21] versus 4% [2-4] in mean inspiratory airway pressure. These results were similar in patients without obesity and the obesity factor was never significant. No adverse event was observed in patients with and without obesity in both modes.
In patients with obesity, NAVA ventilation is feasible and safe, improves patient-ventilator interactions and oxygenation, with an increase ventilatory variability compared to PSV. The effects of NAVA are comparable in patients with and without obesity.
与压力支持通气（PSV）相比，神经调节通气辅助（NAVA）可改善重症监护病房患者与呼吸机的相互作用。尚无研究评估肥胖患者使用NAVA的情况。我们旨在评估肥胖患者使用NAVA的可行性和安全性，并比较肥胖患者与非肥胖患者使用NAVA的情况。
在这项随机交叉研究中，分析了10例肥胖患者和11例非肥胖患者机械通气1小时内的所有呼吸周期。患者随机先后接受30分钟的NAVA和30分钟的PSV。持续记录气流、气道压力和膈肌电活动。在基线及每个30分钟时段结束时采集动脉血气。通过触发延迟、吸气时间过长、不同步周期的发生率和类型评估患者与呼吸机的相互作用。通过变异系数（标准差/均值）评估通气参数的变异性。
所有患者均完成研究，每位患者共分析了1790±873个呼吸周期。在肥胖患者中，与PSV相比，NAVA可显著缩短触发延迟（0[0 - 5]毫秒对106[34 - 125]毫秒，p<0.05）、吸气时间过长（96[94 - 102]毫秒对145[137 - 202]毫秒，p<0.01）及无效呼吸努力（0[0 - 0.03]次/分钟对0.33[0.23 - 0.37]次/分钟，p<0.05）。两种模式下的整体不同步指数相似（2.2%[1.1 - 4.4]对3.7%[2.4 - 5.6]，p = 0.68）。与PSV相比，NAVA时的PaO2/FiO2比值显著升高，分别为238 mmHg[174 - 344]和207 mmHg[164 - 297]，p<0.05。NAVA时的潮气量显著低于PSV，分别为预测体重的6.7 mL/kg[5.9 - 7.1]和7.2 mL/kg[6.2 - 8.2]，p<0.05。NAVA时的通气变异性显著更高，平均吸气气道压力的变异系数分别为16%[11 - 21]和4%[2 - 4]。非肥胖患者的结果相似，肥胖因素无显著影响。两种模式下肥胖患者和非肥胖患者均未观察到不良事件。
在肥胖患者中，NAVA通气可行且安全，可改善患者与呼吸机的相互作用及氧合，与PSV相比通气变异性增加。NAVA在肥胖患者和非肥胖患者中的效果相当。
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