Neurally adjusted ventilatory assist and proportional assist ventilation both improve patient-ventilator interaction

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• 作者：Matthieu Schmidt (1) (2) (3) (6)
  Felix Kindler (3)
  J茅r么me Cecchini (1) (2)
  Tymoth茅e Poitou (4)
  Elise Morawiec (1) (2) (3)
  Romain Persichini (3)
  Thomas Similowski (1) (2) (3)
  Alexandre Demoule (1) (2) (3) (5)
  
  1. Sorbonne Universit茅s ; UPMC Univ Paris 06 ; UMR_S 1158 Neurophysiologie Respiratoire Exp茅rimentale et Clinique ; F-75005 ; Paris ; France
  2. INSERM ; UMR_S 1158 Neurophysiologie Respiratoire Exp茅rimentale et Clinique ; F-75005 ; Paris ; France
  3. AP-HP ; Groupe Hospitalier Piti茅-Salp锚tri猫re Charles Foix ; Service de Pneumologie et R茅animation M茅dicale (D茅partement R3S) ; F-75013 ; Paris ; France
  6. Service de Pneumologie et R茅animation M茅dicale ; Groupe Hospitalier Piti茅-Salp锚tri猫re ; 47-83 boulevard de l鈥橦么pital ; 75651 ; Paris ; Cedex 13 ; France
  4. Universit茅 Pierre et Marie Curie-CNRS-INSERM ; ICM ; Equipe Neurologie et Th茅rapeutique Exp茅rimentale ; H么pital de la Salp锚tri猫re ; Paris ; France
  5. U974 ; Institut National de la Sant茅 et de la Recherche m茅dicale ; Paris ; France
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：639 KB
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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 The objective was to compare the impact of three assistance levels of different modes of mechanical ventilation; neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV), and pressure support ventilation (PSV) on major features of patient-ventilator interaction. Methods PSV, NAVA, and PAV were set to obtain a tidal volume (VT) of 6 to 8聽ml/kg (PSV100, NAVA100, and PAV100) in 16 intubated patients. Assistance was further decreased by 50% (PSV50, NAVA50, and PAV50) and then increased by 50% (PSV150, NAVA150, and PAV150) with all modes. The three modes were randomly applied. Airway flow and pressure, electrical activity of the diaphragm (EAdi), and blood gases were measured. VT, peak EAdi, coefficient of variation of VT and EAdi, and the prevalence of the main patient-ventilator asynchronies were calculated. Results PAV and NAVA prevented the increase of VT with high levels of assistance (median 7.4 (interquartile range (IQR) 5.7 to 10.1) ml/kg and 7.4 (IQR, 5.9 to 10.5) ml/kg with PAV150 and NAVA150 versus 10.9 (IQR, 8.9 to 12.0) ml/kg with PSV150, P EAdi was higher with PAV than with PSV at level100 and level150. The coefficient of variation of VT was higher with NAVA and PAV (19 (IQR, 14 to 31)% and 21 (IQR 16 to 29)% with NAVA100 and PAV100 versus 13 (IQR 11 to 18)% with PSV100, P NAVA than with PSV (P NAVA than with PAV and PSV (P Conclusions PAV and NAVA both prevent overdistention, improve neuromechanical coupling, restore the variability of the breathing pattern, and decrease patient-ventilator asynchrony in fairly similar ways compared with PSV. Further studies are needed to evaluate the possible clinical benefits of NAVA and PAV on clinical outcomes. Trial registration Clinicaltrials.gov NCT02056093. Registered 18 December 2013.