Intensive Care Medicine

, Volume 36, Issue 12, pp 2038–2044

Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support

  • Christian Karagiannidis
  • Matthias Lubnow
  • Alois Philipp
  • Guenter A. J. Riegger
  • Christof Schmid
  • Michael Pfeifer
  • Thomas Mueller
Original

DOI: 10.1007/s00134-010-1982-6

Cite this article as:
Karagiannidis, C., Lubnow, M., Philipp, A. et al. Intensive Care Med (2010) 36: 2038. doi:10.1007/s00134-010-1982-6

Abstract

Purpose

Extracorporeal membrane oxygenation (ECMO) can support oxygenation and carbon dioxide elimination in severe lung failure. Usually it is accompanied by controlled mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is a new mode of ventilation triggered by the diaphragmatic electrical activity and controlled by the patient’s respiratory centre, which may allow a close interaction between ventilation and extracorporeal perfusion. This pilot study intended to measure the physiologic ventilatory response in patients with severe lung failure treated with ECMO and NAVA. We hypothesized that the combination of both methods could automatically provide a protective ventilation with optimized blood gases.

Methods

We report a case series of six patients treated with ECMO for severe lung failure. In the recovery phase of the disease, patients were ventilated with NAVA and ventilatory response and gas exchange parameters were measured under different sweep gas flows and temporarily inactivated ECMO.

Results

Tidal volumes on ECMO ranged between 2 and 5 ml/kg predicted body weight and increased up to 8 ml/kg with inactivated ECMO. Peak inspiratory pressure reached 19–29 cmH2O with active, and 21–45 cmH2O with inactivated ECMO. Ventilatory response to decreased sweep gas flow was rapid, and patients immediately regulated PaCO2 tightly towards a physiological pH value. Increase in minute ventilation was a result of increased breathing frequency and tidal volumes, and protective ventilation was only abandoned if pH control was not achieved.

Conclusions

With NAVA ventilatory response to decreased ECMO sweep gas flow was rapid, and patients immediately regulated PaCO2 tightly towards a physiological pH value. Therefore, combination of NAVA and ECMO may permit a closed-loop ventilation with automated protective ventilation.

Keywords

NAVA ECMO Closed-loop ARDS EAdi 

Abbreviations

NAVA

Neurally adjusted ventilatory assist

EAdi

Electrical activity of the diaphragm

ARDS

Adult respiratory distress syndrome

ECMO

Extracorporeal membrane oxygenation

VIDD

Ventilator-induced diaphragmatic dysfunction

RASS

Richmond Agitation-Sedation Scale

PIP

Peak inspiratory pressure

PEEP

Positive end-expiratory pressure

Supplementary material

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Supplementary material 1 (DOC 46 kb)
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Supplementary material 7 (DOC 79 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Christian Karagiannidis
    • 1
  • Matthias Lubnow
    • 1
  • Alois Philipp
    • 2
  • Guenter A. J. Riegger
    • 1
  • Christof Schmid
    • 2
  • Michael Pfeifer
    • 1
  • Thomas Mueller
    • 1
  1. 1.Department of Internal Medicine IIUniversity Hospital of RegensburgRegensburgGermany
  2. 2.Department of Cardiothoracic SurgeryUniversity Hospital of RegensburgRegensburgGermany

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