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Neural Breathing Pattern and Patient-Ventilator Interaction During Neurally Adjusted Ventilatory Assist and Conventional Ventilation in Newborns

Mally, Pradeep V. MD1; Beck, Jennifer PhD2,3,4; Sinderby, Christer PhD2,3,4,5; Caprio, Martha MD1; Bailey, Sean M. MD1

Pediatric Critical Care Medicine: January 2018 - Volume 19 - Issue 1 - p 48-55
doi: 10.1097/PCC.0000000000001385
Neonatal Intensive Care
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Objective: To compare neurally adjusted ventilatory assist and conventional ventilation on patient-ventilator interaction and neural breathing patterns, with a focus on central apnea in preterm infants.

Design: Prospective, observational cross-over study of intubated and ventilated newborns. Data were collected while infants were successively ventilated with three different ventilator conditions (30 min each period): 1) synchronized intermittent mandatory ventilation (SIMV) combined with pressure support at the clinically prescribed, SIMV with baseline settings (SIMVBL), 2) neurally adjusted ventilatory assist, 3) same as SIMVBL, but with an adjustment of the inspiratory time of the mandatory breaths (SIMV with adjusted settings [SIMVADJ]) using feedback from the electrical activity of the diaphragm).

Setting: Regional perinatal center neonatal ICU.

Patients: Neonates admitted in the neonatal ICU requiring invasive mechanical ventilation.

Measurements and Main Results: Twenty-three infants were studied, with median (range) gestational age at birth 27 weeks (24–41 wk), birth weight 780 g (490–3,610 g), and 7 days old (1–87 d old). Patient ventilator asynchrony, as quantified by the NeuroSync index, was lower during neurally adjusted ventilatory assist (18.3% ± 6.3%) compared with SIMVBL (46.5% ±11.7%; p < 0.05) and SIMVADJ (45.8% ± 9.4%; p < 0.05). There were no significant differences in neural breathing parameters, or vital signs, except for the end-expiratory electrical activity of the diaphragm, which was lower during neurally adjusted ventilatory assist. Central apnea, defined as a flat electrical activity of the diaphragm more than 5 seconds, was significantly reduced during neurally adjusted ventilatory assist compared with both SIMV periods. These results were comparable for term and preterm infants.

Conclusions: Patient-ventilator interaction appears to be improved with neurally adjusted ventilatory assist. Analysis of the neural breathing pattern revealed a reduction in central apnea during neurally adjusted ventilatory assist use.

1Division of Neonatology, NYU School of Medicine, New York, NY.

2Department of Critical Care, Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada.

3Department of Critical Care, Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael’s Hospital, Toronto, ON, Canada.

4Department of Pediatrics, University of Toronto, Toronto, ON, Canada.

5Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Supported, in part, by the RS McLaughlin Foundation and through a research grant from the KiDS of NYU Foundation.

Drs. Beck and Sinderby’s institution (St Michael’s Hospital) has a research agreement with Maquet Critical Care and receives royalty and overhead from this agreement. Dr. Beck received funding from Maquet Critical Care and Neurovent Research, and she disclosed that she has made inventions related to neural control of mechanical ventilation that are patented. The patents are assigned to the academic institution(s) where inventions were made. The license for these patents belongs to Maquet Critical Care. Future commercial uses of this technology may provide financial benefit to Dr. Beck through royalties. Dr. Beck owns 50% of Neurovent Research (NVR). NVR is a research and development company that builds the equipment and catheters for research studies. NVR has a consulting agreement with Maquet Critical Care. Dr. Sinderby received funding from Maquet Critical Care and serves as a consultant for Maquet Critical Care through Neurovent Research, and he disclosed that he has made inventions related to neural control of mechanical ventilation that are patented. The patents are assigned to the academic institution(s) where inventions were made. The license for these patents belongs to Maquet Critical Care. Future commercial uses of this technology may provide financial benefit to Dr. Sinderby through royalties. Dr. Sinderby owns 50% of Neurovent Research (NVR). NVR is a research and development company that builds the equipment and catheters for research studies. NVR has a consulting agreement with Maquet Critical Care. Dr. Beck and Dr. Sinderby are married. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: Pradeep.mally@nyumc.org

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies