Physiologic Comparison Between NIV-NAVA and PS in Preterm Infants

Seoul National University Hospital16 enrolled

Overview

Neurally adjusted ventilatory assist (NAVA) has been shown to improve patient- ventilator interaction and reduce asynchronies. This is a short-term physiologic comparison between PSV (pressure support ventilation) and NAVA in delivering noninvasive ventilation through a nasal cannula, in premature infants postextubation. Patients will undergo a 30-min crossover trial of noninvasive PSV and NAVA, 15 minutes each. Diaphragm electrical activity (EAdi)and airway pressure (Paw) are recorded to derive neural and mechanical respiratory rate and timing, inspiratory trigger delays time of synchrony between diaphragm contraction and ventilator assistance, and the asynchrony index (AI).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Noninvasive Neurally Adjusted Ventilatory Assist and Pressure Support in Preterm Infants

Interventions

Eligibility

Sex: ALLMin age: 3 DaysMax age: 3 Months

Medical Language ↔ Plain English

Inclusion Criteria: * preterm infants less than 32 weeks of gestational age * intubated more than 48 hours after birth * subjected to extubation with minimal ventilator setting (mean airway pressure \< 7cmH2O + peak inspiratory pressure \< 13 cmH2O + FiO2 \< 0.4 + respiratory rate \< 35/min) * with informed consent from parents Exclusion Criteria: * with major congenital anomalies * use of sedative or anesthetic drugs * hemodynamic instability * grade 3 or higher intraventricular hemorrhage * phrenic nerve palsy

Locations (3)

Seoul National University Bundang Hospital

Bundang, Gyeonggi-do, South Korea

Seoul National University Children's Hospital

Seoul, South Korea

Seoul National University Hospital

Seoul, South Korea

Outcomes

Primary Outcomes

Trigger Delay

Inspiratory trigger delay could be calculated by the time interval between beginning of the increase of actual diaphragmatic excitation and start of ventilator inspiratory flow of each respiration. The value will be present as a mean of all inspiratory trigger delay measurements of all respiration during last 5 minutes of each 15 minutes trial.