Effect of changing NAVA levels on peak inspiratory pressures and electrical activity of the diaphragm in premature neonates

Journal of Perinatology : Official Journal of the California Perinatal Association
Kimberly FirestoneH Stein

Abstract

Neurally adjusted ventilator assist (NAVA) uses electrical activity of the diaphragm (Edi) to provide patient-directed ventilatory support. The NAVA level determines the proportional amount of ventilatory support. Systematically increasing NAVA level initially increases peak inspiratory pressure (PIP) while maintaining a constant Edi until a breakpoint (BrP) is reached. Further increases in NAVA level reduce the Edi, while the PIP plateaus. This study was performed to establish whether premature neonates have intact neural feedback systems allowing them to have a BrP. NAVA level was increased by 0.5 cm H2O μV(-1) every 3 min from 0.5 to 4.0 cm H2O μV(-1). PIP, Edi, mean blood pressure, heart rate, respiratory rate, oxygen saturation and FIO2 were recorded. Statistics: Non-linear regression was done for PIP and Edi. Linear regression was done for the other variables. The data from the trials were combined by normalizing to NAVA levels above and below the BrP. Nine neonates were studied on NAVA and 12 on non-invasive NAVA. PIP increased until the BrP was reached and then remained unchanged. Edi decreased after the BrP was reached. All other variables remained unchanged. Neonates demonstrated a BrP suggesting intact neural feedbac...Continue Reading

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Citations

Feb 24, 2016·Seminars in Fetal & Neonatal Medicine·Howard SteinMichael Dunn
Dec 22, 2015·Paediatric Respiratory Reviews·Claudio RabecMarjolaine Georges
Sep 16, 2016·Journal of Perinatology : Official Journal of the California Perinatal Association·B LoVerdeH M Stein
Nov 14, 2016·Clinics in Perinatology·Kimberly S FirestoneHoward Stein
May 12, 2019·Pediatric Pulmonology·Soo Kyung NamYong Hoon Jun
Mar 17, 2020·The Cochrane Database of Systematic Reviews·Dimple GoelTim Schindler
Nov 3, 2017·Archives of Disease in Childhood. Fetal and Neonatal Edition·Yohan SorezeDaniele De Luca
Dec 1, 2019·Pediatric Research·Anton H van KaamLuc J I Zimmermann
Jul 7, 2020·European Journal of Pediatrics·Alison P ProtainHoward M Stein
Jul 1, 2020·Journal of Perinatal Medicine·Katie A HuntAnne Greenough
Dec 26, 2016·Respiratory Physiology & Neurobiology·Lukas BranderChrister Sinderby
Aug 6, 2021·Scientific Reports·Natalia Neumann-KlimasińskaTomasz Szczapa

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