The new NAVA® ventilatory mode with the SERVO-i ventilator (Maquet®) uses the electrical activity of the diaphragm (EADi) as a marker for triggering the respiratory cycle. The EADi is captured by the electrodes of a specific catheter (the Edi® catheter) placed in the esophagus as a regular gastric feeding tube, and relayed to the SERVO-i who displays it and delivers respiratory assistance according to measured Edi signal which allows synchronous assistance, proportional to the respiratory efforts of the patient. To date, no measure of the effectiveness of NAVA NAV has been performed in children with neuromuscular pathology whereas this technique could reduce the use of invasive ventilation, very iatrogenic in these fragile subjects.
This is a prospective, interventional, sequential, open-label research involving ASI II children with acute respiratory decompensation requiring ventilatory support by NIV. Airway pressure, transcutaneous CO2 monitoring and hemodynamic parameters will be recorded continuously during the study, after inclusion of the patient.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
1
The study has 3 phases: 1. Phase 1: The patient is connected to the SERVOi® ventilator in classic VNI mode, which is parameterized according to the patient's needs and then maintained for 30min for measurements. 2. Phase 2: Switch to NAVA mode (1h). * Definition of NAVA parameters: The positive expiratory pressure will not be modified. The NAVA level (the proportionality factor that converts the EADi (microV) to the pressure level in cmH2O was first adjusted according to the actual assisted pressure in the patient in the normal VNI mode. * NAVA period: The ventilatory pressure, as well as the EADI is recorded continuously for 30min after a NAVA adaptation period of about 30min. 3. Phase 3: The patient returns to classic VNI mode with Phase 1 ventilatory settings for a 30 minute recording.
Service de pédiatrie, Hôpital Raymond Poincaré
Garches, Hauts-de-Seine, France
Asynchrony percentage
Asynchrony percentage of non-synchronous breath cycles over all cycles of the measurement period, unaided breaths, self-initiated cycles.
Time frame: At baseline
Feasibility
Frequency of obtaining an EADi signal
Time frame: At baseline
Feasibility
Percentage of effective time spent in activated NAVA mode
Time frame: At baseline
Efficacy and tolerance
Efficacy and tolerance: during the whole of the study period (2h30), the monitoring of transcutaneous CO2 pressure (PtcCO2) will be collected.
Time frame: At 30 minutes and 60 minutes
Efficacy and tolerance
Efficacy and tolerance: during the whole of the study period (2h30), evolution of respiratory rate will be collected.
Time frame: At 30 minutes and 60 minutes
Efficacy and tolerance
O2 saturation will be collected.
Time frame: At 30 minutes and 60 minutes
Efficacy and tolerance
FiO2 after 30 and 60 minutes under each ventilation mode will be collected.
Time frame: At 30 minutes and 60 minutes
Rate of recourse to intubation
Rate of recourse to intubation, patient preference.
Time frame: At baseline
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