Neurally-Adjusted Ventilatory Assist for Noninvasive Ventilation via a Helmet in Subjects With COPD Exacerbation: A Physiologic Study.
BACKGROUND: In patients with COPD exacerbation, noninvasive ventilation (NIV) is strongly recommended. NIV is generally delivered by using patient triggered and flow-cycled pressure support through a face mask. A specific method to generate neurally-controlled pressure support has been shown to impr...
| Publicado en: | Respiratory Care Vol. 64; no. 5; pp. 582 - 590 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
May2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=136258708&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 136258708 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: May2019 vid: 64 iid: 5 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 136258708 136258708 136258708 10.4187/respcare.06502 136258708 ppf: 582 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Neurally-Adjusted Ventilatory Assist for Noninvasive Ventilation via a Helmet in Subjects With COPD Exacerbation: A Physiologic Study. aug: au: Longhini, Federico Ling Liu Chun Pan Jianfeng Xie Cammarota, Gianmaria Bruni, Andrea Garofalo, Eugenio Yi Yang Navalesi, Paolo Haibo Qiu affil: Intensive Care Unit, University Hospital Mater Domini, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy sug: subj: Pulmonary Disease, Chronic Obstructive Physiopathology Disease Exacerbation Physiopathology Respiration, Artificial Methods Noninvasive Procedures Utilization Head Protective Devices Utilization Human China Cross Sectional Studies Physiological Studies Pressure Support Ventilation Pulmonary Gas Exchange Inspiration, Respiratory Tidal Volume Airway Pressure Blood Gas Analysis Masks Utilization Comfort Respiratory Mechanics Airway Management Descriptive Statistics Spearman's Rank Correlation Coefficient Data Analysis Software Male Female Middle Age Aged Aged, 80 and Over Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: BACKGROUND: In patients with COPD exacerbation, noninvasive ventilation (NIV) is strongly recommended. NIV is generally delivered by using patient triggered and flow-cycled pressure support through a face mask. A specific method to generate neurally-controlled pressure support has been shown to improve comfort and patient-ventilator interaction. In addition, the helmet interface was better tolerated by patients compared with a face mask. Herein, we compared neurally-controlled pressure support through a helmet with pressure support through a face mask with respect to subject comfort, breathing pattern, gas exchange, pressurization and triggering performance, and patientventilator synchrony. METHODS: Two 30-min trials of NIV were randomly delivered to 10 subjects with COPD exacerbation redundant: (1) pressure support through a face mask with inspiratory pressure support of ≥8 cmH2O to obtain a tidal volume of 6-8 mL/kg of ideal body weight; and (2) NAVA through a helmet, setting the neurally-adjusted ventilatory assist level at 15 cm H2O/µV, with an upper airway pressure limit to obtain the same overall airway pressure applied during pressure support through a face mask. We assessed subject comfort, breathing frequency, respiratory drive, arterial blood gases, pressure-time product (PTP) of the first 300 ms and 500ms after initiation of subject effort, inspiratory trigger delay, and rate of asynchrony determined as the asynchrony index. RESULTS: Median and interquartile range NAVA through a helmet improved comfort (7.0 [6.0-8.0]) compared with pressure support through a face mask (5.0 [4.7-5.2], P = .005). The breathing pattern was not different between the methods. Respiratory drive was slightly, although not significantly, reduced (P = .19) during NAVA through a helmet in comparison with pressure support through a face mask. Gas exchange was also not different between the trials. The PTP of the first 300 ms (P = .92) and PTP of the first 500 ms (P = .08) were not statistically different between trials, whereas triggering performance, patient-ventilator interaction, and synchrony were all improved by NAVA through a helmet compared with pressure support through a face mask. CONCLUSIONS: In the subjects with COPD with exacerbation, NAVA through a helmet improved comfort, triggering performance, and patient-ventilator synchrony compared with pressure support through a face mask. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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