Assessment of patient-ventilator breath contribution during neurally adjusted ventilatory assist in patients with acute respiratory failure

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• 作者：Ling Liu (1)
  Songqiao Liu (1)
  Jianfeng Xie (1)
  Yi Yang (1)
  Arthur S Slutsky (2) (3)
  Jennifer Beck (2) (4)
  Christer Sinderby (2) (3)
  Haibo Qiu (1)
  
  1. Department of Critical Care Medicine ; Zhongda Hospital ; Southeast University ; School of Medicine ; 87 Dingjiaqiao Street ; Nanjing ; 210009 ; China
  2. Keenan Research Centre for Biomedical Science and Department of Critical Care ; St Michael鈥檚 Hospital ; 30 Bond Street ; Toronto ; ON ; M5B1W8 ; Canada
  3. Department of Medicine and Interdepartmental Division of Critical Care Medicine ; University of Toronto ; Suit RFE3-805 ; 200 Elizabeth Street ; Toronto ; ON ; M5G 2C4 ; Canada
  4. Department of Pediatrics ; University of Toronto ; 555 University Avenue ; Toronto ; ON ; M5G 1X8 ; Canada
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：3,495 KB
• 参考文献：1. Piquilloud, L, Vignaux, L, Bialais, E, Roeseler, J, Sottiaux, T, Laterre, PF (2011) Neurally adjusted ventilatory assist improves patient鈥搗entilator interaction. Intensive Care Med 37: pp. 263-71 CrossRef
  2. Spahija, J, Marchie, M, Albert, M, Bellemare, P, Delisle, S, Beck, J (2010) Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 38: pp. 518-26 CrossRef
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  4. Colombo, D, Cammarota, G, Bergamaschi, V, Lucia, M, Corte, FD, Navalesi, P (2008) Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 34: pp. 2010-8 CrossRef
  5. Terzi, N, Pelieu, I, Guittet, L, Ramakers, M, Seguin, A, Daubin, C (2010) Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: physiological evaluation. Crit Care Med 38: pp. 1830-7 CrossRef
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  7. Wu XY, Huang YZ, Yang Y, Liu SQ, Liu HG, Qiu HB. Effects of neurally adjusted ventilatory assist on patient-ventilator synchrony in patients with acute respiratory distress syndrome. Zhonghua Jie He He Hu Xi Za Zhi. 2009;32:508鈥?2. Chinese.
  8. Piquilloud, L, Tassaux, D, Bialais, E, Lambermont, B, Sottiaux, T, Roeseler, J (2012) Neurally adjusted ventilatory assist (NAVA) improves patient鈥搗entilator interaction during non-invasive ventilation delivered by face mask. Intensive Care Med 38: pp. 1624-31 CrossRef
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  10. Mauri, T, Bellani, G, Grasselli, G, Confalonieri, A, Rona, R, Patroniti, N (2013) Patient鈥搗entilator interaction in ARDS patients with extremely low compliance undergoing ECMO: a novel approach based on diaphragm electrical activity. Intensive Care Med 39: pp. 282-91 CrossRef
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  12. Grasselli, G, Beck, J, Mirabella, L, Pesenti, A, Slutsky, AS, Sinderby, C (2012) Assessment of patient鈥搗entilator breathe contribution during neurally adjusted ventilatory assist. Intensive Care Med 38: pp. 1224-32 CrossRef
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction We previously showed in animals that the ratio of inspired tidal volume (Vtinsp) to inspiratory peak electrical activity of the diaphragm (EAdipk) can be used to quantify the respective patient and ventilator breath contributions (PVBCs) during neurally adjusted ventilatory assist (NAVA). The PVBC index has not been tested clinically. Methods We studied 12 intubated and mechanically ventilated patients with acute respiratory failure and measured EAdipk, airway (Paw) and inspiratory esophageal pressure (Pes) and Vtinsp. We applied 11 different NAVA levels, increasing them every 3聽minutes in steps of 0.3聽cm H2O/渭V from 0 to 3.0 cmH2O/渭V. At each NAVA level, one breath was non-assisted (NAVA level 0). PVBC indices were calculated by relating Vtinsp/EAdipk of the non-assisted breath to Vtinsp/EAdipk of the assisted breath(s) using one (N1PVBC) or the mean value of five preceding assisted breaths (X5PVBC). During assisted breaths, inspiratory changes in Pes (鈭哖es) and transpulmonary (螖Ptp) pressures were used to calculate the relative contribution of patient to total inspiratory lung-distending pressures (螖Pes/螖Ptp). Matching of respiratory drive indices and squaring of the PVBC was evaluated for their effect on the correlation between PVBC and 螖Pes/螖Ptp. Linear regression analysis and Bland-Altman analysis were applied to compare indices. Results Using an average of five assisted breaths prior to the non-assisted breath and squaring the PVBC (X5PVBC2) improved determination coefficients (P P P EAdipk between non-assisted and assisted breaths within the range of 0.77 to 1.30 improved the relationship between X5PVBC2 and 螖Pes/螖Ptp (P EAdi normalization in the PVBC calculation (R 2鈥?鈥?.96; bias鈥?鈥?.16鈥壜扁€?.06; precision鈥?鈥?.33鈥壜扁€?.08 (mean and 95% confidence interval)). Conclusions This clinical study confirms previous experimental results showing that the PVBC2 predicts the contribution of the inspiratory muscles versus that of the ventilator during NAVA, when differences in effort (EAdi) between non-assisted and assisted breaths are limited. PVBC could help to quantify and standardize the adjustment of the level of assist, and hence reduce the risks of excessive ventilatory assist in patients. Trial registration ClinicalTrials.gov NCT01663480. Registered 9 August 2012.