TY - JOUR
T1 - Utilization of Neurally Adjusted Ventilatory Assist (NAVA) Mode in Infants and Children Undergoing Congenital Heart Surgery
T2 - A Retrospective Review
AU - Baez Hernandez, Nathanya
AU - Milad, Abdulhamid
AU - Li, Yi
AU - Van Bergen, Andrew H.
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/3/15
Y1 - 2019/3/15
N2 - We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. The ventilatory and gas exchange parameters for the 24 h pre- and post-transition to NAVA were compared. Additional parameters assessed included pain scores and sedation requirements. Eighty-one patients met inclusion criteria with a median age of 21 days (interquartile range 13 days–2 months). The majority of patients enrolled (75.3%) had complex congenital heart disease with high surgical severity scores. The transition to NAVA was tolerated by all patients without complications. The mean peak inspiratory pressure (PIP) was 1.8 cm H 2 O lower (p < 0.001) and mean airway pressure (P aw ) was 0.5 cm H 2 O lower (p = 0.009) on NAVA compared to conventional modes of mechanical ventilation. There was no significant difference in patients’ respiratory rate, tidal volume, arterial pH, pCO 2 , and lactate levels between the two modes of ventilation. There was a decreased sedation requirement during the time of NAVA ventilation. Comfort scores did not differ significantly with ventilator mode change. We concluded that NAVA is safe and well-tolerated mode of mechanical ventilation for our cohort of patients after congenital heart surgery. Compared to conventional ventilation there was a statistically significant decrease in PIP and P aw on NAVA.
AB - We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. The ventilatory and gas exchange parameters for the 24 h pre- and post-transition to NAVA were compared. Additional parameters assessed included pain scores and sedation requirements. Eighty-one patients met inclusion criteria with a median age of 21 days (interquartile range 13 days–2 months). The majority of patients enrolled (75.3%) had complex congenital heart disease with high surgical severity scores. The transition to NAVA was tolerated by all patients without complications. The mean peak inspiratory pressure (PIP) was 1.8 cm H 2 O lower (p < 0.001) and mean airway pressure (P aw ) was 0.5 cm H 2 O lower (p = 0.009) on NAVA compared to conventional modes of mechanical ventilation. There was no significant difference in patients’ respiratory rate, tidal volume, arterial pH, pCO 2 , and lactate levels between the two modes of ventilation. There was a decreased sedation requirement during the time of NAVA ventilation. Comfort scores did not differ significantly with ventilator mode change. We concluded that NAVA is safe and well-tolerated mode of mechanical ventilation for our cohort of patients after congenital heart surgery. Compared to conventional ventilation there was a statistically significant decrease in PIP and P aw on NAVA.
KW - Congenital heart surgery
KW - Diaphragm activity
KW - Mechanical ventilation
KW - Neurally adjusted ventilatory assist
KW - Pediatrics
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U2 - 10.1007/s00246-018-2027-0
DO - 10.1007/s00246-018-2027-0
M3 - Article
C2 - 30600371
AN - SCOPUS:85059331239
SN - 0172-0643
VL - 40
SP - 563
EP - 569
JO - Pediatric Cardiology
JF - Pediatric Cardiology
IS - 3
ER -