Pressure support ventilation, sigh adjunct to pressure support ventilation, and neurally adjusted ventilatory assist in infants after cardiac surgery: A physiologic crossover randomized study.

Authors:
Daniele Bonacina
Daniele Bonacina
Centro Cardiologico Monzino
Italy
Alfio Bronco
Alfio Bronco
San Gerardo Hospital
Italy
Mirco Nacoti
Mirco Nacoti
Riuniti Hospital
Italy
Ezio Bonanomi
Ezio Bonanomi
Pediatric intensive care
Giacomo Bellani
Giacomo Bellani
University of Milan-Bicocca
Italy

Pediatr Pulmonol 2019 Jul 19;54(7):1078-1086. Epub 2019 Apr 19.

Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.

Objectives: We sought to compare gas exchange, respiratory mechanics, and asynchronies during pressure support ventilation (PSV), sigh adjunct to PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in hypoxemic infants after cardiac surgery.

Design: Prospective, single-center, crossover, randomized physiologic study.

Setting: Tertiary-care pediatric intensive care unit.

Patients: Fourteen hypoxemic infants (median age 11.5 days [8.7-74]).

Interventions: The protocol begins with a 1 hour step of PSV, followed by two consecutive steps in PSV SIGH and NAVA in random order, with a washout period of 30 minutes (PSV) between them.

Main Results: Three infants presented an irregular Eadi signal because of diaphragmatic paralysis and were excluded from analysis. For the remaining 11 infants, PaO /FiO and oxygenation index improved in PSV SIGH compared with PSV (P < 0.05) but not in NAVA compared with PSV. PSV SIGH showed increased tidal volumes and lower respiratory rate than PSV (P < 0.05), as well as a significant improvement in compliance with respiratory system indexed to body weight when compared with both PSV and NAVA (P < 0.01). No changes in mean airway pressure was registered among steps. Inspiratory time resulted prolonged for both PSV SIGH and NAVA than PSV (P < 0.05). NAVA showed the higher coefficient of variability in respiratory parameters and a significative decrease in asynchrony index when compared with both PSV and PSV SIGH (P < 0.01).

Conclusions: The adjunct of one SIGH per minute to PSV improved oxygenation and lung mechanics while NAVA provided the best patient-ventilator synchrony in infants after cardiac surgery.

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.24335DOI Listing
July 2019
1 Read

Article Mentions


Provided by Crossref Event Data
twitter
Twitter:
April 20, 2019, 4:18 am EST

Publication Analysis

Top Keywords

psv sigh
16
support ventilation
12
pressure support
12
adjusted ventilatory
8
infants cardiac
8
psv
8
neurally adjusted
8
crossover randomized
8
ventilatory assist
8
sigh adjunct
8
hypoxemic infants
8
infants
5
sigh
5
single-center crossover
4
[87-74]interventions protocol
4
days [87-74]interventions
4
protocol 1 hour
4
step psv
4
steps psv
4
sigh nava
4

References

(Supplied by CrossRef)
Airway closure, atelectasis and gas exchange during anaesthesia
Hedenstierna G. et al.
Minerva Anestesiol 2002

Similar Publications