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Piastra, M.1; De Luca, D.M.2; Marzano, L.3; Biasucci, D.G.3; Genovese, O.3; Pizza, A.3; Picconi, E.3; Conti, G.3
1Emergency Department, Picu - Institute of Anesthesia/Intensive Care, Roma, Italy 2Pediatrics Beclere Paris Sud University Hospital, Neonatal ICU, Paris, France 3Emergency Department, Picu, Roma, Italy
Background and aims: Neurally adjusted ventilatory assist (NAVA) is a new ventilator modality with an innovative synchronization technique.
Aims: Our aim is to verify if NAVA is feasible and safe in terms of physiological and clinical variables in infants recovering from severe ARDS.
Methods: Infants affected by severe ARDS requiring high frequency ventilation, weaned with NAVA during 2010. Controls (2:1 ratio) were ARDS infants weaned with pressure support (PSV) during 2008–2009, matched for age, gas exchange impairment and weight.Setting: 3rd level academic pediatric intensive care units. Main outcome measures were physiological and ventilator parameters, duration of ventilator supporto in PSV or NAVA.
Results: 10 infants treated with NAVA and 20 with PSV were studied. Heart rate (p<0.001) and mean arterial pressure (p<0.001) increased less during NAVA than during PSV. Similarly, PaO2/FiO2 ratio decreased less in NAVA than in PSV (p<0.001). NAVA also resulted in lower PaCO2 (p<0.001) and peak pressure (p=0.001), as well as higher minute ventilation (p=0.013). COMFORT score (p=0.004) and duration of support were lower in NAVA than in PSV (p=0.011).
Conclusions: NAVA is safe and suitable in infants recovering from severe ARDS requiring HFOV as a rescue mode of ventilation. NAVA could provide better results than PSV and is worth to be investigated in a multicentre randomised trial.
©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
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