Intensive Care Medicine

, Volume 37, Issue 12, pp 1943–1950 | Cite as

Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation

  • Gianmaria Cammarota
  • Carlo Olivieri
  • Roberta Costa
  • Rosanna Vaschetto
  • Davide Colombo
  • Emilia Turucz
  • Federico Longhini
  • Francesco Della Corte
  • Giorgio Conti
  • Paolo NavalesiEmail author



Neurally adjusted ventilatory assist (NAVA) has been shown to improve patient–ventilator interaction and reduce asynchronies in intubated patients, as opposed to pressure support ventilation (PSV). This is a short-term head-to-head physiologic comparison between PSV and NAVA in delivering noninvasive ventilation through a helmet (h-NIV), in patients with postextubation hypoxemic acute respiratory failure.


Ten patients underwent three 20-min trials of h-NIV in PSV, NAVA, and PSV again. Arterial blood gases (ABGs) were assessed at the end of each trial. Diaphragm electrical activity (EAdi) and airway pressure (P aw) were recorded to derive neural and mechanical respiratory rate and timing, inspiratory (delayTR-insp) and expiratory trigger delays (delayTR-exp), time of synchrony between diaphragm contraction and ventilator assistance (timesynch), and the asynchrony index (AI).


ABGs, peak EAdi, peak P aw, respiratory rate, either neural or mechanical, neural timing, and delayTR-exp were not different between trials. Compared with PSV, with NAVA the mechanical expiratory time was significantly shorter, while the inspiratory time and duty cycle were greater. Timesynch was 0.79 ± 0.35 s in NAVA versus 0.60 ± 0.30 s and 0.55 ± 0.29 s during the PSV trials (p < 0.01 for both). AI exceeded 10% during both PSV trials, while not in NAVA (p < 0.001).


Compared with PSV, NAVA improves patient–ventilator interaction and synchrony, with no difference in gas exchange, respiratory rate, and neural drive and timing.


Noninvasive ventilation Helmet Patient–ventilator interaction Patient–ventilator asynchrony Neurally adjusted ventilatory assist (NAVA) Pressure support ventilation (PSV) 



This work has not been funded by any external source. The preliminary results of this study were presented at the 2009 meeting of the European Society of Intensive Care Medicine, Vienna. CO and PN contributed to the development of a new interface, whose license for patent belongs to Starmed S.p.A., and might receive royalties for that invention in the future.

Supplementary material

134_2011_2382_MOESM1_ESM.doc (54 kb)
Supplementary material 1 (DOC 53 kb)


  1. 1.
    Evans TW (2001) International consensus conferences in intensive care medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors. Intensive Care Med 27:166–178PubMedCrossRefGoogle Scholar
  2. 2.
    Squadrone E, Frigerio P, Fogliati C, Gregoretti C, Conti G, Antonelli M, Costa R, Baiardi P, Navalesi P (2004) Noninvasive versus invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance. Intensive Care Med 30:1303–1310PubMedCrossRefGoogle Scholar
  3. 3.
    Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880PubMedGoogle Scholar
  4. 4.
    Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S (2000) Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure. Crit Care Med 28:1785–1790PubMedCrossRefGoogle Scholar
  5. 5.
    Vignaux L, Vargas F, Roeseler J, Tassaux D, Thille AW, Kossowsky MP, Brochard L, Jolliet P (2009) Patient–ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med 35:840–846PubMedCrossRefGoogle Scholar
  6. 6.
    Antonelli M, Conti G, Pelosi P, Gregoretti C, Pennisi MA, Costa R, Severgnini P, Chiaranda M, Proietti R (2002) New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet—a pilot controlled trial. Crit Care Med 30:602–608PubMedCrossRefGoogle Scholar
  7. 7.
    Antonelli M, Pennisi MA, Pelosi P, Gregoretti C, Squadrone V, Rocco M, Cecchini L, Chiumello D, Severgnini P, Proietti R, Navalesi P, Conti G (2004) Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease: a feasibility study. Anesthesiology 100:16–24PubMedCrossRefGoogle Scholar
  8. 8.
    Navalesi P, Costa R, Ceriana P, Carlucci A, Prinianakis G, Antonelli M, Conti G, Nava S (2007) Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask. Intensive Care Med 33:74–81PubMedCrossRefGoogle Scholar
  9. 9.
    Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433–1436PubMedCrossRefGoogle Scholar
  10. 10.
    Navalesi P, Costa R (2003) New modes of mechanical ventilation: proportional assist ventilation, neurally adjusted ventilatory assist, and fractal ventilation. Curr Opin Crit Care 9:51–58PubMedCrossRefGoogle Scholar
  11. 11.
    Moerer O, Beck J, Brander L, Costa R, Quintel M, Slutsky AS, Brunet F, Sinderby C (2008) Subject–ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Med 34:1615–1623PubMedCrossRefGoogle Scholar
  12. 12.
    Colombo D, Cammarota G, Bergamaschi V, De 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 34:2010–2018PubMedCrossRefGoogle Scholar
  13. 13.
    Navalesi P, Hernandez P, Wongsa A, Laporta D, Goldberg P, Gottfried SB (1996) Proportional assist ventilation in acute respiratory failure: effects on breathing pattern and inspiratory effort. Am J Respir Crit Care Med 154:1330–1338PubMedGoogle Scholar
  14. 14.
    Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient–ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522PubMedCrossRefGoogle Scholar
  15. 15.
    Vargas F, Thille A, Lyazidi A, Campo FR, Brochard L (2009) Helmet with specific settings versus facemask for noninvasive ventilation. Crit Care Med 37:1921–1928PubMedCrossRefGoogle Scholar
  16. 16.
    Terzi N, Pelieu I, Guittet L, Ramakers M, Seguin A, Daubin C, Charbonneau P, du Cheyron D, Lofaso F (2010) Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: physiological evaluation. Crit Care Med 38:1830–1837PubMedCrossRefGoogle Scholar
  17. 17.
    Karagiannidis C, Lubnow M, Philipp A, Riegger GA, Schmid C, Pfeifer M, Mueller T (2010) Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med 36:2038–2044PubMedCrossRefGoogle Scholar
  18. 18.
    Schmidt M, Demoule A, Cracco C, Gharbi A, Fiamma MN, Straus C, Duguet A, Gottfried SB, Similowski T (2010) Neurally adjusted ventilatory assist increases respiratory variability and complexity in acute respiratory failure. Anesthesiology 112:670–681PubMedCrossRefGoogle Scholar
  19. 19.
    Brander L, Leong-Poi H, Beck J, Brunet F, Hutchison SJ, Slutsky AS, Sinderby C (2009) Titration and implementation of neurally adjusted ventilatory assist in critically ill patients. Chest 135:695–703PubMedCrossRefGoogle Scholar
  20. 20.
    Parthasarathy S, Jubran A, Tobin MJ (2000) Assessment of neural inspiratory time in ventilator-supported patients. Am J Respir Crit Care Med 162:546–552PubMedGoogle Scholar
  21. 21.
    Piquilloud L, Vignaux L, Bialais E, Roeseler J, Sottiaux T, Laterre PF, Jolliet P, Tassaux D (2011) Neurally adjusted ventilatory assist improves patient–ventilator interaction. Intensive Care Med 37:263–271PubMedCrossRefGoogle Scholar
  22. 22.
    Spahija J, de Marchie M, Albert M, Bellemare P, Delisle S, Beck J, Sinderby C (2010) Patient–ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 38:518–526PubMedCrossRefGoogle Scholar
  23. 23.
    Costa R, Navalesi P, Antonelli M, Cavaliere F, Craba A, Proietti R, Conti G (2005) Physiologic evaluation of different levels of assistance during noninvasive ventilation delivered through a helmet. Chest 128:2984–2990PubMedCrossRefGoogle Scholar
  24. 24.
    Abdel-Hady H, Mohareb S, Khashaba M, Abu-Alkhair M, Greisen G (1998) Randomized controlled trial of discontinuation of nasal-CPAP in stable preterm infants breathing room air. Acta Paediatr 87:82–87PubMedCrossRefGoogle Scholar
  25. 25.
    Achour L, Letellier C, Cuvelier A, Verin E, Muir JF (2007) Asynchrony and cyclic variability in pressure support noninvasive ventilation. Comput Biol Med 37:1308–1320PubMedCrossRefGoogle Scholar
  26. 26.
    Costa R, Navalesi P, Spinazzola G, Ferrone G, Pellegrini A, Cavaliere F, Proietti R, Antonelli M, Conti G (2010) Influence of ventilator settings on patient–ventilator synchrony during pressure support ventilation with different interfaces. Intensive Care Med 36:1363–1370PubMedCrossRefGoogle Scholar
  27. 27.
    Nava S, Bruschi C, Fracchia C, Braschi A, Rubini F (1997) Patient–ventilator interaction and inspiratory effort during pressure support ventilation in patients with different pathologies. Eur Respir J 10:177–183PubMedCrossRefGoogle Scholar
  28. 28.
    Tassaux D, Gainnier M, Battisti A, Jolliet P (2005) Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med 172:1283–1289PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Gianmaria Cammarota
    • 1
  • Carlo Olivieri
    • 1
  • Roberta Costa
    • 2
  • Rosanna Vaschetto
    • 1
  • Davide Colombo
    • 1
  • Emilia Turucz
    • 3
  • Federico Longhini
    • 3
  • Francesco Della Corte
    • 1
    • 3
  • Giorgio Conti
    • 2
  • Paolo Navalesi
    • 3
    • 4
    Email author
  1. 1.Anesthesia and Intensive CareMaggiore della Carità University HospitalNovaraItaly
  2. 2.Department of Anesthesiology and Intensive CareUniversità Cattolica del Sacro Cuore, A. Gemelli University HospitalRomeItaly
  3. 3.Department of Clinical and Experimental MedicineUniversità del Piemonte Orientale “Amedeo Avogadro” Alessandria-Novara-VercelliNovaraItaly
  4. 4.Anesthesia and Intensive CareSant’Andrea HospitalVercelliItaly

Personalised recommendations