Respiratory physiology during NAVA ventilation in neonates born with a congenital diaphragmatic hernia: The "NAVA-diaph" pilot study. Dreyfus, L., Butin, M., Plaisant, F., Claris, O., & Baudin, F. Pediatric Pulmonology, 58(5):1542–1550, May, 2023. doi abstract bibtex BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that delivers synchronized ventilation, proportional to the electrical activity of the diaphragm (EAdi). Although it has been proposed in infants with a congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm. AIM: To evaluate, in a pilot study, the relationship between the respiratory drive (EAdi) and the respiratory effort in neonates with CDH during the postsurgical period under either NAVA ventilation or conventional ventilation (CV). METHODS: This prospective physiological study included eight neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric, and transdiaphragmatic pressure, as well as clinical parameters, were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the postsurgical period. RESULTS: EAdi was detectable and there was a correlation between the ΔEAdi (maximal - minimal values) and the transdiaphragmatic pressure (r = 0.26, 95% confidence interval [CI] [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing. CONCLUSION: Respiratory drive and effort were correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. EAdi can also be used to monitor the diaphragm for individualized support.
@article{dreyfus_respiratory_2023,
title = {Respiratory physiology during {NAVA} ventilation in neonates born with a congenital diaphragmatic hernia: {The} "{NAVA}-diaph" pilot study},
volume = {58},
issn = {1099-0496},
shorttitle = {Respiratory physiology during {NAVA} ventilation in neonates born with a congenital diaphragmatic hernia},
doi = {10.1002/ppul.26357},
abstract = {BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that delivers synchronized ventilation, proportional to the electrical activity of the diaphragm (EAdi). Although it has been proposed in infants with a congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm.
AIM: To evaluate, in a pilot study, the relationship between the respiratory drive (EAdi) and the respiratory effort in neonates with CDH during the postsurgical period under either NAVA ventilation or conventional ventilation (CV).
METHODS: This prospective physiological study included eight neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric, and transdiaphragmatic pressure, as well as clinical parameters, were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the postsurgical period.
RESULTS: EAdi was detectable and there was a correlation between the ΔEAdi (maximal - minimal values) and the transdiaphragmatic pressure (r = 0.26, 95\% confidence interval [CI] [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing.
CONCLUSION: Respiratory drive and effort were correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. EAdi can also be used to monitor the diaphragm for individualized support.},
language = {eng},
number = {5},
journal = {Pediatric Pulmonology},
author = {Dreyfus, Lélia and Butin, Marine and Plaisant, Frank and Claris, Olivier and Baudin, Florent},
month = may,
year = {2023},
pmid = {36807570},
keywords = {Diaphragm, Hernias, Diaphragmatic, Congenital, Humans, Infant, Infant, Newborn, Interactive Ventilatory Support, NAVA ventilation, Pilot Projects, Prospective Studies, Respiration, Artificial, Respiratory Rate, congenital diaphragmatic hernia, respiratory physiology, transpulmonary pressure, work of breathing},
pages = {1542--1550},
}
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Although it has been proposed in infants with a congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm. AIM: To evaluate, in a pilot study, the relationship between the respiratory drive (EAdi) and the respiratory effort in neonates with CDH during the postsurgical period under either NAVA ventilation or conventional ventilation (CV). METHODS: This prospective physiological study included eight neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric, and transdiaphragmatic pressure, as well as clinical parameters, were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the postsurgical period. RESULTS: EAdi was detectable and there was a correlation between the ΔEAdi (maximal - minimal values) and the transdiaphragmatic pressure (r = 0.26, 95% confidence interval [CI] [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing. CONCLUSION: Respiratory drive and effort were correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. EAdi can also be used to monitor the diaphragm for individualized support.","language":"eng","number":"5","journal":"Pediatric Pulmonology","author":[{"propositions":[],"lastnames":["Dreyfus"],"firstnames":["Lélia"],"suffixes":[]},{"propositions":[],"lastnames":["Butin"],"firstnames":["Marine"],"suffixes":[]},{"propositions":[],"lastnames":["Plaisant"],"firstnames":["Frank"],"suffixes":[]},{"propositions":[],"lastnames":["Claris"],"firstnames":["Olivier"],"suffixes":[]},{"propositions":[],"lastnames":["Baudin"],"firstnames":["Florent"],"suffixes":[]}],"month":"May","year":"2023","pmid":"36807570","keywords":"Diaphragm, Hernias, Diaphragmatic, Congenital, Humans, Infant, Infant, Newborn, Interactive Ventilatory Support, NAVA ventilation, Pilot Projects, Prospective Studies, Respiration, Artificial, Respiratory Rate, congenital diaphragmatic hernia, respiratory physiology, transpulmonary pressure, work of breathing","pages":"1542–1550","bibtex":"@article{dreyfus_respiratory_2023,\n\ttitle = {Respiratory physiology during {NAVA} ventilation in neonates born with a congenital diaphragmatic hernia: {The} \"{NAVA}-diaph\" pilot study},\n\tvolume = {58},\n\tissn = {1099-0496},\n\tshorttitle = {Respiratory physiology during {NAVA} ventilation in neonates born with a congenital diaphragmatic hernia},\n\tdoi = {10.1002/ppul.26357},\n\tabstract = {BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that delivers synchronized ventilation, proportional to the electrical activity of the diaphragm (EAdi). Although it has been proposed in infants with a congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm.\nAIM: To evaluate, in a pilot study, the relationship between the respiratory drive (EAdi) and the respiratory effort in neonates with CDH during the postsurgical period under either NAVA ventilation or conventional ventilation (CV).\nMETHODS: This prospective physiological study included eight neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric, and transdiaphragmatic pressure, as well as clinical parameters, were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the postsurgical period.\nRESULTS: EAdi was detectable and there was a correlation between the ΔEAdi (maximal - minimal values) and the transdiaphragmatic pressure (r = 0.26, 95\\% confidence interval [CI] [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing.\nCONCLUSION: Respiratory drive and effort were correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. 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