The use of neurally-adjusted ventilatory assist (NAVA) during noninvasive ventilation (NIV) results in better patient-ventilator interaction. Whether this improves clinical outcomes lacks dedicated study.
METHODS:
In this randomized controlled trial, we compared NAVA with PSV for delivering NIV in consecutive subjects with de novo acute respiratory failure. The primary outcomes were NIV failure rates and 28-d mortality. The secondary outcomes were asynchrony index, NIV-related complications, and others.
RESULTS:
We enrolled 100 subjects (50 subjects each for NAVA and PSV, 60% male) with a mean ± SD age of 56.7 ± 12 y. There was no difference in NIV failure rates (30% vs 32%, P = .83) and 28-d mortality rates (18% vs 34%, P = .07) between the NAVA and PSV arms, respectively. The median asynchrony index was significantly lower with NAVA (6.7 vs 44.8, P < .001). The use of NAVA significantly reduced NIV-related complications (32% vs 58%, P = .01). In a post hoc analysis, the use of NAVA significantly reduced the 28-d mortality in subjects with COPD exacerbation.
CONCLUSIONS:
The use of NAVA during NIV did not improve NIV failure rate or 28-d mortality in subjects with acute respiratory failure. However, patient-ventilator asynchrony and NIV-related complications were reduced with NAVA.
RochwergB, BrochardL, ElliottMW, HessD, HillNS, NavaS, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J, 2017; 50(2):1602426.
2.
StricklandSL. The patient experience during noninvasive respiratory support. Respir Care, 2019; 64(6):689-700.
3.
GeorgopoulosD, PrinianakisG, KondiliE. Bedside waveforms interpretation as a tool to identify patient-ventilator asynchronies. Intensive Care Med, 2006; 32(1):34-47.
4.
VignauxL, VargasF, RoeselerJ, TassauxD, ThilleAW, KossowskyMP, et al. Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med, 2009; 35(5):840-846.
5.
SinderbyC, NavalesiP, BeckJ, SkrobikY, ComtoisN, FribergS, et al. Neural control of mechanical ventilation in respiratory failure. Nat Med, 1999; 5(12):1433-1436.
6.
BeckJ, GottfriedSB, NavalesiP, SkrobikY, ComtoisN, RossiniM, et al. Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med, 2001; 164(3):419-424.
7.
SehgalIS, DhooriaS, AggarwalAN, BeheraD, AgarwalR. Asynchrony index in pressure support ventilation (PSV) versus neurally adjusted ventilator assist (NAVA) during non-invasive ventilation (NIV) for respiratory failure: systematic review and meta-analysis. Intensive Care Med, 2016; 42(11):1813-1815.
8.
TerziN, PiquilloudL, RozéH, MercatA, LofasoF, DelisleS, et al. Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference. Crit Care, 2012; 16(3):225.
9.
NavaS, GregorettiC, FanfullaF, SquadroneE, GrassiM, CarlucciA, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med, 2005; 33(11):2465-2470.
10.
BaldiM, SehgalIS, DhooriaS, BeheraD, AgarwalR. Neurally adjusted ventilation assist in weaning difficulty: First case report from India. Indian J Crit Care Med, 2016; 20(6):364-367.
11.
CarteauxG, Cordoba-IzquierdoA, LyazidiA, HeunksL, ThilleAW, BrochardL. Comparison between neurally adjusted ventilatory assist and pressure support ventilation levels in terms of respiratory effort. Crit Care Med, 2016; 44(3):503-511.
12.
LecomteF, BranderL, JaldeF, BeckJ, QuiH, ElieC, et al. Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA). Respir Physiol Neurobiol, 2009; 166(2):117-124.
13.
PiquilloudL, TassauxD, BialaisE, LambermontB, SottiauxT, RoeselerJ, et al. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction during non-invasive ventilation delivered by face mask. Intensive Care Med, 2012; 38(10):1624-1631.
14.
SehgalIS, KalpakamH, DhooriaS, AggarwalAN, PrasadKT, AgarwalR. A randomized controlled trial of noninvasive ventilation with pressure support ventilation and adaptive support ventilation in acute exacerbation of COPD: a feasibility study. COPD, 2019; 16(2):168-173.
SehgalIS, AgarwalR. Non-invasive ventilation in acute respiratory distress syndrome: helmet use saves lives?. Ann Transl Med, 2016; 4(18):349.
17.
OsadnikCR, TeeVS, Carson-ChahhoudKV, PicotJ, WedzichaJA, SmithBJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2017; 7:Cd004104.
18.
AgarwalR, GuptaR, AggarwalAN, GuptaD. Noninvasive positive pressure ventilation in acute respiratory failure due to COPD vs other causes: effectiveness and predictors of failure in a respiratory ICU in North India. Int J Chron Obstruct Pulmon Dis, 2008; 3(4):737-743.
19.
CammarotaG, OlivieriC, CostaR, VaschettoR, ColomboD, TuruczE, et al. Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation. Intensive Care Med, 2011; 37(12):1943-1950.
20.
BertrandPM, FutierE, CoiselY, MateckiS, JaberS, ConstantinJM. Neurally adjusted ventilatory assist vs pressure support ventilation for noninvasive ventilation during acute respiratory failure: a crossover physiologic study. Chest, 2013; 143(1):30-36.
21.
DoorduinJ, SinderbyCA, BeckJ, van der HoevenJG, HeunksLM. Automated patient-ventilator interaction analysis during neurally adjusted non-invasive ventilation and pressure support ventilation in chronic obstructive pulmonary disease. Crit Care, 2014; 18(5):550.
22.
AgarwalR, AggarwalAN, GuptaD. Role of noninvasive ventilation in acute lung injury/acute respiratory distress syndrome: a proportion meta-analysis. Respir Care, 2010; 55(12):1653-1660.
23.
SehgalIS, ChaudhuriS, DhooriaS, AgarwalR, ChaudhryD. A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome. Indian J Crit Care Med, 2015; 19(10):593-599.
24.
TajamulS, HaddaV, MadanK, TiwariP, MittalS, KhanMA, et al. Neurally-adjusted ventilatory assist versus noninvasive pressure support ventilation in COPD exacerbation: the NAVA-NICE Trial. Respir Care, 2020; 65(1):53-61.
25.
SinderbyC, BeckJ, SpahijaJ, de MarchieM, LacroixJ, NavalesiP, et al. Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest, 2007; 131(3):711-717.
