PDF(1034 KB)
Application of neurally adjusted ventilatory assist in infants who underwent cardiac surgery for congenital heart disease
ZHU Li-Min, SHI Zhen-Ying, JI Gang, XU Zhuo-Ming, ZHENG Jing-Hao, ZHANG Hai-Bo, XU Zhi-Wei, LIU Jin-Fen
Chinese Journal of Contemporary Pediatrics ›› 2009, Vol. 11 ›› Issue (06) : 433-436.
PDF(1034 KB)
PDF(1034 KB)
Application of neurally adjusted ventilatory assist in infants who underwent cardiac surgery for congenital heart disease
OBJECTIVE: Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to neural effort. This study aimed to compare the hemodynamic safety, oxygenation and gas exchange effects ventilated with NAVA and with pressure support ventilation (PSV) in infants who underwent open-heart surgery. METHODS: Twenty-one infants who underwent open-heart surgery for congenital heart disease (mean age 2.9±2.1 months and mean weight 4.2±1.4 kg) were enrolled. They were ventilated with PSV and NAVA for 60 minutes respectively in a randomized order. The hemodynamic, oxygenation and gas exchange effects produced by the two ventilation modes were compared. RESULTS: Three cases failed to shift to NAVA because of the bilateral diaphragmatic paralysis after operation. In the other 18 cases, there were no significant differences in the heart rate (HR), systolic blood pressure (BPs) and central venous pressure (CVP) in the two ventilation modes. The PaO2/FiO2 (P/F) ratio in NAVA was slightly higher than in PSV, but there was no statistical difference. PaCO2 did not show significant differences in the two modes. The peak inspiratory pressure (PIP) and electrical activity of the diaphragm (EAdi) in NAVA were significantly lower than in PSV. The EAdi signal after extubation was higher in infants who needed reintubation or intervention of noninvasive mechanical ventilation than in those who were extubated successfully (30.0±8.4 μV vs 11.1±3.6 μV; P<0.01). CONCLUSIONS: As the first study of application of NAVA in infants in China, this study shows that NAVA has the same homodynamic effects as PSV. However the PIP for maintaining the same level of PaCO2 in NAVA is significantly lower than that in the traditional PSV. Monitoring the EAdi signal after extubation may show the risks of reintubation or intervention of noninvasive mechanical ventilation.［Chin J Contemp Pediatr, 2009, 11 (6):433-436］
Pressure support ventilation / Neurally adjusted ventilatory assist / Electrical activity of the diaphragm / Congenital heart disease / Infant
［1］Marraro GA. 机械通气在儿科病人中的应用：最新进展及肺保护性策略［J］.中国当代儿科杂志，2005，7（3）：278-282.
［2］Grasso S, Puntillo F, Mascia L, Ancona G, Fiore T, Bruno F, et al. Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportionalassist ventilation［J］. Am J Respir Crit Care Med, 2000, 161(3 Pt 1):819-826.
［3］Colombo D, Cammarota G, Bergamaschi V, De Lucia M, Corte FD, Navalesi P. Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure ［J］. Intensive Care Med, 2008, 34(11):2010-2018.
［4］Rigby-Jones AE, Priston MJ, Sneyd JR, McCabe AP, Davis GI, Tooley MA, et al. Remifentanil-midazolam sedation for paediatric patients receiving mechanical ventilation after cardiac surgery ［J］. Br J Anaesth, 2007, 99(2):252-261.
［5］Kallef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation ［J］. Chest, 1998, 114(2):541-548.
［6］Sinderby C. Neurally adjusted ventilatory assist (NAVA) ［J］. Minerva Anestesiol, 2002, 68(5):378-380.
［7］Sinderby C, Beck J. Proportional assist ventilation and neurally adjusted ventilatory assist－better approaches to patient ventilator synchrony?［J］. Clin Chest Med, 2008, 29(2):329-342.
［8］Sinderby C, Beck J, Spahija J, de Marchie M, Lacroix J, Navalesi P, et al. Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects［J］. Chest, 2007, 131(3):711-717.
［9］Beck J, Brander L, Slutsky AS, Reilly MC, Dunn MS, Sinderby C. Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury ［J］. Intensive Care Med, 2008, 34(2):316-323.
［10］Moerer O, Beck J, Brander L, Costa R, Quintel M, Slutsky AS, et al. Subject-ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation ［J］. Intensive Care Med, 2008, 34(9):1615-1623.
［11］Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, et al. Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure［J］. Am J Respir Crit Care Med, 2001, 164(3):419-924.
