The purpose of this study is to test the hypothesis that neurally adjusted ventilatory assist (NAVA) will allow to lower the ventilator pressure at equivalent fractions of inspiratory oxygen (FiO2) and partial pressure of CO2 of capillary blood in preterm infants in comparison with currently used standard ventilation (synchronized intermittent mandatory ventilation with pressure-support ventilation, SIMV+PSV).
The investigators will apply crossover comparison in preterm infants who received a ventilatory support. In patient whose frequency of mandatory support is under 25, the two ventilatory modes (SIMV+PSV and NAVA) are delivered by the same ventilator (Servo-I; Maquet Critical Care AB, Solna, Sweden) and will set to maintain similar blood gas analysis results. Determination of the type of ventilatory mode used is performed using a cluster randomization. The randomized order of ventilatory mode will be used during total 9 hours; one mode for 4 hours and another mode for 5 hours. To rule out carry-over effects, a 1-hour interval for washout was guaranteed between modes. Recordings will be obtained over a total 8 hours.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
26
Neurally adjusted ventilatory assist (NAVA) utilizes the electrical activity of the diaphragm (EAdi) to trigger and cycle-off breaths, and therefore presents a means of bypassing the ventilator circuit, and the inherent delays with pneumatic triggering. This is a processed signal, which is not artificially influenced by changes in muscle length, chest wall configuration, and/or lung volume. It represents the summation of muscle motor unit recruitment and/or firing rate, and correlates with phrenic nerve activity. In this mode, the amount of support pressure is coupled with the magnitude of the EAdi. The proportion of support pressure to EAdi (NAVA level) is adjustable.
Seoul National University Children's Hospital
Seoul, South Korea
Peak Inspiratory Pressure
peak inspiratory pressure measured by a ventilator for 4 hours with each ventilator mode
Time frame: four hours
Mean Airway Pressure
mean airway pressure measured by a ventilator for 4 hours with each ventilator mode
Time frame: four hours
Minute Ventilation
Minute ventilation measured by a ventilator for 4 hours with each ventilator mode
Time frame: four hours
Expiratory Tidal Volume
Expiratory tidal volume measured by a ventilator for 4 hours with each ventilator mode
Time frame: four hours
Dynamic Compliance
Dynamic Compliance measured by a ventilator for 4 hours with each ventilator mode
Time frame: four hours
Work of Breathing
Work of breathing of patients measured by a ventilator for 4 hours with each ventilator mode
Time frame: four hours
Peak EAdi
Peak electrical activity of the diaphragm
Time frame: four hours
Fraction of Oxygen
Fraction of oxygen measured by a ventilator for 4 hours with each ventilator mode
Time frame: four hours
Capillary Blood pH
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Capillary blood pH checked immediately after the 4-hour respiratory support with each ventilator mode
Time frame: four hours
Capillary Blood pCO2
Capillary blood pCO2 checked immediately after the 4-hour respiratory support with each ventilator mode
Time frame: four hours
Capillary Blood pO2
Capillary blood pO2 checked immediately after the 4-hour respiratory support with each ventilator mode
Time frame: four hours
Capillary Blood HCO3
Capillary blood HCO3 checked immediately after the 4-hour respiratory support with each ventilator mode
Time frame: four hours