Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-09-30

AUTHORS

A. Demoule, M. Clavel, C. Rolland-Debord, S. Perbet, N. Terzi, A. Kouatchet, F. Wallet, H. Roze, F. Vargas, C. Guerin, J. Dellamonica, S. Jaber, L. Brochard, T. Similowski

ABSTRACT

PurposeNeurally adjusted ventilatory assist (NAVA) is a ventilatory mode that tailors the level of assistance delivered by the ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation.MethodsA multicentre randomized controlled trial of 128 intubated adults recovering from acute respiratory failure was conducted in 11 intensive care units. Patients were randomly assigned to NAVA or PSV. The primary outcome was the probability of remaining in a partial ventilatory mode (either NAVA or PSV) throughout the first 48 h without any return to assist-control ventilation. Secondary outcomes included asynchrony index, ventilator-free days and mortality.ResultsIn the NAVA and PSV groups respectively, the proportion of patients remaining in partial ventilatory mode throughout the first 48 h was 67.2 vs. 63.3 % (P = 0.66), the asynchrony index was 14.7 vs. 26.7 % (P < 0.001), the ventilator-free days at day 7 were 1.0 day [1.0–4.0] vs. 0.0 days [0.0–1.0] (P < 0.01), the ventilator-free days at day 28 were 21 days [4–25] vs. 17 days [0–23] (P = 0.12), the day-28 mortality rate was 15.0 vs. 22.7 % (P = 0.21) and the rate of use of post-extubation noninvasive mechanical ventilation was 43.5 vs. 66.6 % (P < 0.01).ConclusionsNAVA is safe and feasible over a prolonged period of time but does not increase the probability of remaining in a partial ventilatory mode. However, NAVA decreases patient–ventilator asynchrony and is associated with less frequent application of post-extubation noninvasive mechanical ventilation.Trial Registration. clinicaltrials.gov Identifier: NCT02018666. More... »

PAGES

1723-1732

Journal

TITLE

Intensive Care Medicine

ISSUE

11

VOLUME

42

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-016-4447-8

DOI

http://dx.doi.org/10.1007/s00134-016-4447-8

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1028295036

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27686347


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353 schema:name Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
354 Réanimation Médicale et Chirurgicale, Centre Hospitalier Lyon-Sud, Lyon, France
355 rdf:type schema:Organization
356 grid-institutes:grid.494717.8 schema:alternateName R2D2 EA-7281, Université d’Auvergne, Clermont-Ferrand, France
357 schema:name R2D2 EA-7281, Université d’Auvergne, Clermont-Ferrand, France
358 Réanimation Médico-Chirurgicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
359 rdf:type schema:Organization
 




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