Continuous neurally adjusted ventilation: a feasibility study in preterm infants.

To assess the feasibility and tolerance of NeuroPAP, a new non-invasive ventilation mode which continuously adjusts (during both inspiration and expiration) the pressure support proportionally to the diaphragm electrical activity (Edi), in preterm infants and to evaluate the impact on ventilation pressure and Edi. Prospective cross-over single-centre feasibility study. One level 3 neonatal intensive care unit in Canada. Stable preterm infants ventilated with non-invasive positive pressure ventilation (NIPPV). Subjects were successively ventilated in NIPPV with prestudy settings (30 min), in NeuroPAP with minimal pressure similar to NIPPV PEEP (positive end-expiratory pressure) (60 min), in NeuroPAP with minimal pressure reduced by 2 cmH Twenty infants born at 28.0±1.0 weeks were included. NeuroPAP was well tolerated and could be delivered during 100% of planned period. During NeuroPAP, the PEEP was continuously adjusted proportionally to tonic diaphragm Edi, although the average PEEP value was similar to the set minimal pressure. During NeuroPAP, 83 (78-86)% breaths were well synchronised vs 9 (6-12)% breaths during NIPPV (p<0.001). NeuroPAP is feasible and well tolerated in stable preterm infants, and it allows transient adaptation in PEEP in response to tonic diaphragm electrical activity changes. Further studies are warranted to determine the impact of these findings on clinical outcomes. NCT02480205.

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Déclaration de conflit d'intérêts

Competing interests: GE’s research programme is supported by a scholarship award by the Fonds de Recherche du Québec—Santé. JB and CS have made inventions related to neural control of mechanical ventilation that are patented. The patents are assigned to the academic institution(s) where inventions were made. The licence for these patents belongs to Maquet Critical Care. Future commercial uses of this technology may provide financial benefit to JB and CS through royalties. JB and CS each own 50% of Neurovent Research Inc (NVR). NVR is a research and development company that builds the equipment and catheters for research studies. NVR has a consulting agreement with Maquet Critical Care. The remaining authors have no conflicts of interest to disclose.