Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial
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Neurally 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.
A 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.
In 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).
NAVA 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.
KeywordsMechanical ventilation Weaning Neurally adjusted ventilatory assist Patient–ventilator asynchrony Ventilator-free days Noninvasive ventilation
Compliance with ethical standards
Conflicts of interest
This study is an investigator-initiated trial that received financial support from Maquet. Maquet had no access to the data and was not involved in the analysis or writing of the manuscript. Alexandre Demoule has signed research contracts with Covidien, Maquet and Philips; he has also received personal fees from Covidien, Maquet and MSD. Samir Jaber has received personal fees from Dräger, Fisher and Paykel, Hamilton, and Maquet. Laurent Brochard declares research contracts with Covidien, Dräger, General Electric, as well as equipment provided by Maquet and by Philips for research protocols. Thomas Similowski belongs to the board of a research association that has received, over the past 10 years, unrestricted research grants from Maquet, Hamilton, Covidien and Philips; he is the head of a research unit (UMRS 1158) that has signed research contracts with Air Liquide Medical Systems, France; he declares no personal conflict of interest with mechanical ventilation firms; he is listed as inventor or co-inventor on several patents, granted or pending, describing a brain–ventilator interface. Marc Clavel, Camille Rolland-Debord, Sebastien Perbet, Nicolas Terzi, Achille Kouatchet, Florent Wallet, Hadrien Roze, Frederic Vargas, Claude Guerin and Jean Dellamonica have no conflict of interest related to this work.
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