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Effect of changing NAVA levels on peak inspiratory pressures and electrical activity of the diaphragm in premature neonates

Journal of Perinatology volume 35, pages 612–616 (2015)Cite this article

Subjects

Abstract

Background:

Neurally adjusted ventilator assist (NAVA) uses electrical activity of the diaphragm (Edi) to provide patient-directed ventilatory support. The NAVA level determines the proportional amount of ventilatory support. Systematically increasing NAVA level initially increases peak inspiratory pressure (PIP) while maintaining a constant Edi until a breakpoint (BrP) is reached. Further increases in NAVA level reduce the Edi, while the PIP plateaus. This study was performed to establish whether premature neonates have intact neural feedback systems allowing them to have a BrP.

Method:

NAVA level was increased by 0.5 cm H2O μV−1 every 3 min from 0.5 to 4.0 cm H2O μV−1. PIP, Edi, mean blood pressure, heart rate, respiratory rate, oxygen saturation and FIO2 were recorded. Statistics: Non-linear regression was done for PIP and Edi. Linear regression was done for the other variables. The data from the trials were combined by normalizing to NAVA levels above and below the BrP.

Result:

Nine neonates were studied on NAVA and 12 on non-invasive NAVA. PIP increased until the BrP was reached and then remained unchanged. Edi decreased after the BrP was reached. All other variables remained unchanged.

Conclusion:

Neonates demonstrated a BrP suggesting intact neural feedback mechanisms that may protect lungs from over distention with NAVA ventilation.

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Acknowledgements

This study was supported by Promedica Toledo Children’s Hospital and Akron Children’s Hospital.

Author Contributions

KSF, SF, SR and HMS contributed to study concept and design, data collection, analysis and interpretation and in writing of the manuscript. DBW contributed to statistical design, data analysis and in writing of the manuscript.

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Authors and Affiliations

  1. Neonatology, Akron Children's Hospital, Akron, OH, USA

    K S Firestone

  2. Promedica Physician Group, Blissfield, MI, USA

    S Fisher

  3. Dayton Gastroenterology, Beavercreek, OH, USA

    S Reddy

  4. Mathematics and Statistics, The University of Toledo, Toledo, OH, USA

    D B White

  5. Neonatology, Promedica Toledo Children's Hospital, Toledo, OH, USA

    H M Stein

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  1. K S Firestone
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  2. S Fisher
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  3. S Reddy
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  5. H M Stein
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Correspondence to H M Stein.

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Competing interests

Howard M Stein and Kimberly S Firestone are speakers for MAQUET. All other authors declare no conflict of interest.

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Firestone, K., Fisher, S., Reddy, S. et al. Effect of changing NAVA levels on peak inspiratory pressures and electrical activity of the diaphragm in premature neonates. J Perinatol 35, 612–616 (2015). https://doi.org/10.1038/jp.2015.14

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