A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population.

Hdl Handle:
http://hdl.handle.net/10147/207455
Title:
A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population.
Authors:
Breatnach, Cormac; Conlon, Niamh P; Stack, Maria; Healy, Martina; O'Hare, Brendan P
Affiliation:
Department of Anesthesia and Intensive Care Medicine, Our Lady's Hospital for, Sick Children, Crumlin, Dublin, Ireland.
Citation:
Pediatr Crit Care Med. 2010 Jan;11(1):7-11.
Journal:
Pediatric critical care medicine : a journal of the Society of Critical Care, Medicine and the World Federation of Pediatric Intensive and Critical Care, Societies
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207455
DOI:
10.1097/PCC.0b013e3181b0630f
PubMed ID:
19593246
Abstract:
OBJECTIVE: To compare neurally adjusted ventilatory assist ventilation with pressure-support ventilation. DESIGN: Prospective, crossover comparison study. SETTING: Tertiary care pediatric and neonatal intensive care unit. PATIENTS: Sixteen ventilated infants and children: mean age = 9.7 months (range = 2 days-4 yrs) and mean weight = 6.2 kg (range = 2.4-13.7kg). INTERVENTIONS: A modified nasogastric tube was inserted and correct positioning was confirmed. Patients were ventilated in pressure-support mode with a pneumatic trigger for a 30-min period and then in neurally adjusted ventilatory assist mode for up to 4 hrs. MEASUREMENTS AND MAIN RESULTS: Data collected for comparison included activating trigger (neural vs. pneumatic), peak and mean airway pressures, expired minute and tidal volumes, heart rate, respiratory rate, pulse oximetry, end-tidal CO2 and arterial blood gases. Synchrony was improved in neurally adjusted ventilatory assist mode with 65% (+/-21%) of breaths triggered neurally vs. 35% pneumatically (p < .001) and 85% (+/-8%) of breaths cycled-off neurally vs. 15% pneumatically (p = .0001). The peak airway pressure in neurally adjusted ventilatory assist mode was significantly lower than in pressure-support mode with a 28% decrease in pressure after 30 mins (p = .003) and 32% decrease after 3 hrs (p < .001). Mean airway pressure was reduced by 11% at 30 mins (p = .13) and 9% at 3 hrs (p = .31) in neurally adjusted ventilatory assist mode although this did not reach statistical significance. Patient hemodynamics and gas exchange remained stable for the study period. No adverse patient events or device effects were noted. CONCLUSIONS: In a neonatal and pediatric intensive care unit population, ventilation in neurally adjusted ventilatory assist mode was associated with improved patient-ventilator synchrony and lower peak airway pressure when compared with pressure-support ventilation with a pneumatic trigger. Ventilating patients in this new mode seem to be safe and well tolerated.
Language:
eng
MeSH:
Cross-Over Studies; Diaphragm/innervation/physiology; Female; Humans; Infant; Infant, Newborn; *Intensive Care Units, Neonatal; *Intensive Care Units, Pediatric; Ireland; Male; Positive-Pressure Respiration/*methods; Prospective Studies; Treatment Outcome
ISSN:
1529-7535 (Print); 1529-7535 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorBreatnach, Cormacen_GB
dc.contributor.authorConlon, Niamh Pen_GB
dc.contributor.authorStack, Mariaen_GB
dc.contributor.authorHealy, Martinaen_GB
dc.contributor.authorO'Hare, Brendan Pen_GB
dc.date.accessioned2012-02-01T10:25:27Z-
dc.date.available2012-02-01T10:25:27Z-
dc.date.issued2012-02-01T10:25:27Z-
dc.identifier.citationPediatr Crit Care Med. 2010 Jan;11(1):7-11.en_GB
dc.identifier.issn1529-7535 (Print)en_GB
dc.identifier.issn1529-7535 (Linking)en_GB
dc.identifier.pmid19593246en_GB
dc.identifier.doi10.1097/PCC.0b013e3181b0630fen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207455-
dc.description.abstractOBJECTIVE: To compare neurally adjusted ventilatory assist ventilation with pressure-support ventilation. DESIGN: Prospective, crossover comparison study. SETTING: Tertiary care pediatric and neonatal intensive care unit. PATIENTS: Sixteen ventilated infants and children: mean age = 9.7 months (range = 2 days-4 yrs) and mean weight = 6.2 kg (range = 2.4-13.7kg). INTERVENTIONS: A modified nasogastric tube was inserted and correct positioning was confirmed. Patients were ventilated in pressure-support mode with a pneumatic trigger for a 30-min period and then in neurally adjusted ventilatory assist mode for up to 4 hrs. MEASUREMENTS AND MAIN RESULTS: Data collected for comparison included activating trigger (neural vs. pneumatic), peak and mean airway pressures, expired minute and tidal volumes, heart rate, respiratory rate, pulse oximetry, end-tidal CO2 and arterial blood gases. Synchrony was improved in neurally adjusted ventilatory assist mode with 65% (+/-21%) of breaths triggered neurally vs. 35% pneumatically (p < .001) and 85% (+/-8%) of breaths cycled-off neurally vs. 15% pneumatically (p = .0001). The peak airway pressure in neurally adjusted ventilatory assist mode was significantly lower than in pressure-support mode with a 28% decrease in pressure after 30 mins (p = .003) and 32% decrease after 3 hrs (p < .001). Mean airway pressure was reduced by 11% at 30 mins (p = .13) and 9% at 3 hrs (p = .31) in neurally adjusted ventilatory assist mode although this did not reach statistical significance. Patient hemodynamics and gas exchange remained stable for the study period. No adverse patient events or device effects were noted. CONCLUSIONS: In a neonatal and pediatric intensive care unit population, ventilation in neurally adjusted ventilatory assist mode was associated with improved patient-ventilator synchrony and lower peak airway pressure when compared with pressure-support ventilation with a pneumatic trigger. Ventilating patients in this new mode seem to be safe and well tolerated.en_GB
dc.language.isoengen_GB
dc.subject.meshCross-Over Studiesen_GB
dc.subject.meshDiaphragm/innervation/physiologyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfanten_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.mesh*Intensive Care Units, Neonatalen_GB
dc.subject.mesh*Intensive Care Units, Pediatricen_GB
dc.subject.meshIrelanden_GB
dc.subject.meshMaleen_GB
dc.subject.meshPositive-Pressure Respiration/*methodsen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleA prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population.en_GB
dc.contributor.departmentDepartment of Anesthesia and Intensive Care Medicine, Our Lady's Hospital for, Sick Children, Crumlin, Dublin, Ireland.en_GB
dc.identifier.journalPediatric critical care medicine : a journal of the Society of Critical Care, Medicine and the World Federation of Pediatric Intensive and Critical Care, Societiesen_GB
dc.description.provinceLeinster-

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