Nichtinvasive Beatmung mit neurally adjusted ventilatory assist (NAVA) im Vergleich zur druckunterstützten Beatmung nach Extubation bei Patienten mit Indikation zur nichtinvasiven Beatmung

by Jana Erler née Mann
Doctoral thesis
Date of Examination:2023-01-18
Date of issue:2023-01-10
Advisor:Dr. Lars-Olav Harnisch
Referee:Prof. Dr. Onnen Mörer
Referee:PD Dr. Thorsten Perl
Persistent Address: http://dx.doi.org/10.53846/goediss-9648

 

 

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Abstract

English

Introduction: Asynchrony between patient and ventilator is common under conventional pneumatically triggered ventilation procedures such as pressure support ventilation (PSV) and is an important factor in NIV failure. It has been shown that neurally adjusted ventilatory assist (NAVA) can improve patient-ventilator interaction and reduce work of breathing by deriving the EAdi signal. Methods: In this object-blind, randomized crossover study, 22 patients were ventilated in NIV-NAVA and NIV-PSV mode. The breathing curves were recorded, the blood gas values evaluated and the comfort of the patient was recorded. Results: the negative pressure swing (p < 0.001), the inspiratory trigger delay (p < 0.0005) and the expiratory trigger delay (p = 0.003) were significantly shorter under NAVA than under PSV. In NAVA mode, the occurrence of all asynchronous events could be reduced, only double triggering occurred significantly more frequently than under PSV (p = 0.02). Ineffective efforts could be completely avoided under NAVA. The Neuro-Sync index (trigger and cycle-off delays and all forms of asynchrony) was lower under NAVA than under PSV (p < 0.001). The evaluation of blood gas values and patient comfort showed no significant differences. Conclusions: Even if no positive effect on comfort could be proven, the clinical application of NAVA promises efficient and lung-friendly ventilation with reduced work of breathing due to the improved synchronicity between patient and ventilator. In particular, patients with pre-existing respiratory diseases such as severe COPD or acute respiratory distress syndrome (ARDS) could benefit from NAVA. It could be the subject of future studies to include these patient groups. It would also be interesting to compare the intubation rate and outcome of patients under NAVA and PSV.
Keywords: NIV; NAVA; PSV; noninvasive; ventilation; asynchrony
 
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