Pressure Support Ventilation Versus Neurally Adjusted Ventilatory Assist in Difficult to Wean Pediatric Patients

Fondazione Policlinico Universitario Agostino Gemelli IRCCS12 enrolled

Overview

This study assessed the effects of NAVA versus Pressure Support Ventilation (PSV) on patient-ventilator interaction in pediatric patients with difficult weaning from mechanical ventilation after moderate Pediatric Acute Respiratory Distress Syndrome (PARDS).

12 pediatric patients, admitted in Pediatric Intensive Care Unit (PICU) with moderate PARDS and who failed up to 3 SBTs in less than 7 days, were enrolled in this study. These patients underwent three studies conditions, lasting 1 hour each: Pressure support ventilation 1, Neurally adjusted ventilatory assist and Pressure support ventilation 2. During each trial were recorded the patient tracings of flow, airway pressure and electrical activity of diaphragm for the patient-ventilator interaction analysis.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Distress Respiratory Syndrome Weaning Failure

Interventions

pressure support ventilation versus neurally adjusted ventilatory assistDEVICE

All patients underwent three mechanical ventilation modes, lasting 1 hour each: pressure support mode, neurally adjusted ventilatory assist and again pressure support ventilation

Eligibility

Sex: ALLMin age: 1 MonthMax age: 2 Years

Medical Language ↔ Plain English

Inclusion Criteria: * diagnosis of moderate PARDS * 3 spontaneous breathing trials failed in less than 7 days Exclusion Criteria: * hemodynamic instability * severe respiratory instability * contraindication to nasogastric tube exchange * increase in intracranial pressure * palliative care for end-stage oncologic disease * neuromuscular disease * lesions of medulla

Outcomes

Primary Outcomes

asynchrony index

in each study condition, the asynchrony index was measured. The asynchrnony index value grater than 10% is an indicator of worsening patient-ventilator interaction. the Asynchrony Index is the ratio between the number of asynchronous events and the total respiratory rate, expressed as percentage

Time frame: three years

Secondary Outcomes

patient-ventilator interaction

the variable describing patient-ventilator interaction is the inspiratory trigger delay (defined as the time lag between the onset of neural inspiration and the onset of ventilatory assistance and measured in milliseconds )

Time frame: three years

interaction

another variable describing patient-ventilator interaction is the expiratory trigger delay ( defined as the time lag between the neural expiration and the end of mechanical assistance and measured in milliseconds)

Time frame: three years

synchrony between patient and mechanical ventilator

the time of synchrony is the time during which the patient inspiratory effort and the ventilatory assistance are in phase and measured in milliseconds).

Time frame: three years

Data from ClinicalTrials.gov

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