Effects of Varying Levels of Inspiratory Assistance with Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist on Driving Pressure in Patients Recovering from Hypoxemic Respiratory Failure.
Driving pressure
Neurally adjusted ventilatory assist
Pressure support ventilation
Journal
Journal of clinical monitoring and computing
ISSN: 1573-2614
Titre abrégé: J Clin Monit Comput
Pays: Netherlands
ID NLM: 9806357
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
17
11
2020
accepted:
28
01
2021
pubmed:
10
2
2021
medline:
25
5
2022
entrez:
9
2
2021
Statut:
ppublish
Résumé
Driving pressure can be readily measured during assisted modes of ventilation such as pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). The present prospective randomized crossover study aimed to assess the changes in driving pressure in response to variations in the level of assistance delivered by PSV vs NAVA. 16 intubated adult patients, recovering from hypoxemic acute respiratory failure (ARF) and undergoing assisted ventilation, were randomly subjected to six 30-min-lasting trials. At baseline, PSV (PSV100) was set with the same regulation present at patient enrollment. The corresponding level of NAVA (NAVA100) was set to match the same inspiratory peak of airway pressure obtained in PSV100. Therefore, the level of assistance was reduced and increased by 50% in both ventilatory modes (PSV50, NAVA50; PSV150, NAVA150). At the end of each trial, driving pressure obtained in response to four short (2-3 s) end-expiratory and end-inspiratory occlusions was analyzed. Driving pressure at PSV50 (6.6 [6.1-7.8] cmH NAVA delivers better lung-protective ventilation compared to PSV in hypoxemic ARF patients. The present trial was prospectively registered at www.clinicatrials.gov (NCT03719365) on 24 October 2018.
Sections du résumé
BACKGROUND
Driving pressure can be readily measured during assisted modes of ventilation such as pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). The present prospective randomized crossover study aimed to assess the changes in driving pressure in response to variations in the level of assistance delivered by PSV vs NAVA.
METHODS
16 intubated adult patients, recovering from hypoxemic acute respiratory failure (ARF) and undergoing assisted ventilation, were randomly subjected to six 30-min-lasting trials. At baseline, PSV (PSV100) was set with the same regulation present at patient enrollment. The corresponding level of NAVA (NAVA100) was set to match the same inspiratory peak of airway pressure obtained in PSV100. Therefore, the level of assistance was reduced and increased by 50% in both ventilatory modes (PSV50, NAVA50; PSV150, NAVA150). At the end of each trial, driving pressure obtained in response to four short (2-3 s) end-expiratory and end-inspiratory occlusions was analyzed.
RESULTS
Driving pressure at PSV50 (6.6 [6.1-7.8] cmH
CONCLUSIONS
NAVA delivers better lung-protective ventilation compared to PSV in hypoxemic ARF patients.
TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION
The present trial was prospectively registered at www.clinicatrials.gov (NCT03719365) on 24 October 2018.
Identifiants
pubmed: 33559864
doi: 10.1007/s10877-021-00668-2
pii: 10.1007/s10877-021-00668-2
pmc: PMC7871131
doi:
Banques de données
ClinicalTrials.gov
['NCT03719365']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
419-427Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.
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