Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist.

@article{Roz2013NeuroventilatoryED,
  title={Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist.},
  author={Hadrien Roz{\'e} and Benjamin Repusseau and Virginie Perrier and Arnaud Germain and R{\'e}gis Seramondi and Antoine Dewitte and Catherine Fleureau and Alexandre Ouattara},
  journal={British journal of anaesthesia},
  year={2013},
  volume={111 6},
  pages={
          955-60
        }
}
BACKGROUND Neuro-ventilatory efficiency (NVE), defined as the tidal volume to electrical diaphragm-activity ratio (VT/EAdi) at the beginning and end of the weaning process after acute hypoxaemic respiratory failure, may provide valuable information about patient recovery. METHODS This observational study included 12 patients breathing with neurally adjusted ventilatory assist (NAVA). When a spontaneous breathing trial (SBT) with pressure support of 7 cm H2O and PEEP was unsuccessful, NAVA was… 
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Highly Influential Citations
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Background Citations
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Citation Type

Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial
TLDR
NAVA reduces patient-ventilator asynchrony index and generates a respiratory pattern similar to PSV during SBTs, and may be submitted to an SBT in NAVA using the same objective criteria used for SBTs in PSV.
Neurally adjusted ventilatory assist : from animal studies to clinical practice
TLDR
It is demonstrated that NAVA improves patient-ventilator synchrony for increased assist levels and unloads the respiratory muscles with lower pressures and volumes compared to PS.
Neurally adjusted ventilatory assist feasibility during anaesthesia
TLDR
NVA is feasible during ketamine-propofol and ketamine -sevoflurane anaesthesia in pigs and warrant studies of NAVA in humans undergoing anaesthesia.
Neurally Adjusted Ventilatory Assist During Weaning From Respiratory Support in a Case of Guillain-Barré Syndrome
TLDR
Neurally adjusted ventilatory assist (NAVA) allowed proper patient-ventilator synchronization by pressure support proportional to the electrical activity of the diaphragm (Edi) in a case of Guillain-Barré syndrome complicated by respiratory failure requiring mechanical ventilation.
Effect of flumazenil on diaphragm electrical activation during weaning from mechanical ventilation after acute respiratory distress syndrome.
TLDR
During weaning from mechanical ventilation, the diaphragmatic contribution to the breathing process may be reduced by residual midazolam-induced ventilatory depression, and the increased EAdi with reversal of residual sedation was associated with a proportional increase in VT.
Standardized Unloading of Respiratory Muscles during Neurally Adjusted Ventilatory Assist: A Randomized Crossover Pilot Study
TLDR
In this pilot study, NAVA could be titrated to different diaphragm unloading levels based on the NVE index, and less unloading was associated with greater diphragm activity and improved ventilation of the dependent lung regions.
Patient‐ventilator interaction with conventional and automated management of pressure support during difficult weaning from mechanical ventilation
Relation between peak and integral of the diaphragm electromyographic activity at different levels of support during weaning from mechanical ventilation: a physiologic study.
Control of respiratory drive by extracorporeal CO2 removal in acute exacerbation of COPD breathing on non-invasive NAVA
TLDR
This study demonstrates for the first time the usefulness of the Edi signal to monitor and guide patients with severe acute exacerbation of COPD on vv-ECCO2R and NIV-NAVA.
Neurally adjusted ventilatory assist: An update
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References

SHOWING 1-10 OF 18 REFERENCES
Daily titration of neurally adjusted ventilatory assist using the diaphragm electrical activity
TLDR
Results suggest that daily titration of NAVA level with an electrical goal of ~60% EAdimaxSBT is feasible and well tolerated, and the respiratory mechanics improvement and increase in respiratory drive allowed for a daily reduction of the NAVAlevel while preserving breathing, oxygenation, and alveolar ventilation until extubation.
Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure
TLDR
Compared to PSV, NAVA averted the risk of over-assistance, avoided patient–ventilator asynchrony, and improved patient– ventilator interaction.
Neurally Adjusted Ventilatory Assist in Critically Ill Postoperative Patients: A Crossover Randomized Study
TLDR
Compared with PSV, respiratory parameter variability was greater with NAVA, probably leading in part to the significant improvement in patient oxygenation.
Physiologic response to changing positive end-expiratory pressure during neurally adjusted ventilatory assist in sedated, critically ill adults.
TLDR
During NAVAal, increasing PEEP reduces respiratory drive and patients adapt their neuroventilatory efficiency such that the individual ventilatory pattern is preserved over a wide range of PEEP levels.
Neurally adjusted ventilatory assist improves patient–ventilator interaction
TLDR
Compared with standard PS, NAVA can improve patient–ventilator synchrony in intubated spontaneously breathing intensive care patients and further studies should aim to determine the clinical impact of this improved synchrony.
Neuroventilatory efficiency and extubation readiness in critically ill patients
TLDR
This study shows that a mixed group of critically ill patients for whom weaning fails have increased neural respiratory drive and impaired ability to convert neuromuscular activity into tidal ventilation, in part because of diaphragm weakness.
Diaphragm electromyographic activity as a predictor of weaning failure
TLDR
EAdi-derived indices provide reliable and early predictors of weaning outcome, however, the performance of these indices is not better than the RR/VT.
Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects.
TLDR
In healthy subjects, NAVA can safely and efficiently unload the respiratory muscles during maximal inspiratory maneuvers, without failing to cycle-off ventilatory assist and without causing excessive lung distention.
Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist*
TLDR
Neurally adjusted ventilatory assist can improve patient-ventilator synchrony by reducing the triggering and cycling delays, especially at higher levels of assist, at the same time preserving breathing and maintaining blood gases.
A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation.
TLDR
Rapid shallow breathing, as reflected by the f/VT ratio, was the most accurate predictor of failure, and its absence the most accurately predictor of success, in weaning patients from mechanical ventilation.
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