The Use of Neurally Adjusted Ventilatory Assist (NAVA) Versus Pressure Support During Asynchrony in Children - Full Text View

Purpose

The aim of the current study is to compare the application neurally adjusted ventilatory assist (NAVA) to optimize pressure support ventilation in 12 pediatric patients.

Condition	Intervention
Patient/Ventilator Asynchrony	Other: Pressure Support Ventilation Other: Neurally adjusted ventilatory assist (NAVA)

Study Type:	Interventional
Study Design:	Endpoint Classification: Safety/Efficacy Study Intervention Model: Crossover Assignment Masking: Open Label Primary Purpose: Diagnostic
Official Title:	The Use of NAVA vs. Pressure Support During Asynchrony in Children

Further study details as provided by Hospital Universitario La Paz:

Primary Outcome Measures:

Level of asynchrony [ Time Frame: 3 hours ] [ Designated as safety issue: Yes ]
Number of each defined forms of asynchrony per minute during pressure support and during NAVA Six forms of asynchrony will be identified during optimal pressure support and optimal NAVA: trigger asynchrony, breath initiation asynchrony and breath termination asynchrony, demand asynchrony, inspiratory asynchrony and neuro-asynchrony

Estimated Enrollment:	12
Study Start Date:	July 2010
Estimated Study Completion Date:	July 2011
Estimated Primary Completion Date:	July 2011 (Final data collection date for primary outcome measure)

Intervention Details:

Spontaneous mode of ventilation whereby the patient initiates the breath and the ventilator delivers support with the preset pressure value

Gas delivery from the mechanical ventilator is triggered, controlled and cycled by the diaphragmatic EMG signal (Edi).

The ventilator is aware of the change in diaphragmatic EMG by the insertion of a specially designed nasogastric tube with EMG electrodes that cross the diaphragm.

Detailed Description:

Asynchrony during assisted ventilation in children is common because of the presence of uncuffed artificial airways and their rapid ventilatory rate with small volumes compared to adults.As a result, the most common approach to ventilatory support in children is pressure ventilation, since pressure targeted ventilation allows gas delivery to vary based on patient demand. In addition, many manufacturers have incorporated adjuncts designed to improve synchrony in pressure targeted ventilation. Most of today's ICU ventilators incorporate rise time and control of the breath termination criteria in pressure ventilation by either altering inspiratory time directly or adjusting the inspiratory flow termination criteria in pressure support ventilation. In addition, careful adjustment of trigger sensitivity, and insuring driving pressure is appropriately set to avoid large tidal volumes improves synchrony in many patients. However, in spite of all of these potential adjustments many pediatric patients are still asynchronous.

A recently released new mode of ventilation, NAVA (neurally adjusted ventilatory assist) is designed to reduce the asynchrony that exists between the ventilator and the patient. With NAVA, gas delivery from the mechanical ventilator is triggered, controlled and cycled by the diaphragmatic EMG signal (Edi). The ventilator is aware of the change in diaphragmatic EMG by the insertion of a specially designed nasogastric tube (NGT) with EMG electrodes that cross the diaphragm. This NGT also functions similar to any standard NGT. NAVA is used to control all aspects of assisted ventilatory support. A number of preliminary studies in neonates and pediatric patients have demonstrated that patient ventilator synchrony is improved with the application of NAVA. In general, tidal volumes delivered by the ventilator are decreased, respiratory rates increased and peak inspiratory pressures decreased. In these studies, triggering and cycling of the ventilator are controlled by the diaphragmatic EMG in more than 70 % of the time. If the EMG signal does not activate or terminate positive pressure backup flow/pressure/time signal, control gas delivery -as is customary in standard modes of ventilatory support- takes over.

We hypothesize that the use of NAVA will improve trigger and flow synchrony in children and insure that tidal volumes are normalized (6 to 8 ml/kg) in these patients.

Asynchrony will be studied in 12 mechanically ventilated pediatric patients in the Pediatric ICU at Hospital Universitario Materno-Infantil La Paz in Madrid, Spain.

The study protocol has 5 phases

Phase 0: patient asynchrony documentation and 10 min recording
Phase 1: NAVA catheter insertion and 10 min recording in basal ventilatory mode after 20 min stabilization
Phase 2: Pressure support is optimized and 10 min recording after 20 min stabilization
Phase 3: NAVA mode ventilation and 10 min recording after 20 min stabilization
Phase 4: Pressure support ventilation and 10 min recording after 20 min stabilization

Eligibility

Ages Eligible for Study:	1 Month to 18 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Trigger asynchrony
Breath initiation asynchrony
Breath termination asynchrony
Patient ventilated by Servo i (Maquet Critical Care AB,Solna,Sweden)
Patients breathing spontaneously with no control breaths

Exclusion Criteria:

Shock
Agitation
Asynchrony caused by pain
Abundant tracheal secretions

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01159106

Contacts

Contact: Pedro De La Oliva, MD, PhD

poliva.hulp@salud.madrid.org

Locations

Spain
Hospital Universitario La Paz	Recruiting
Madrid, Spain, 28046
Contact: Pedro de la Oliva, MD PhD +347277149 poliva.hulp@salud.madrid.org
Principal Investigator: Pedro de la Oliva, MD PhD
Sub-Investigator: Ana Gomez, MD
Sub-Investigator: Cristina Schuffelmann, MD

Sponsors and Collaborators

Hospital Universitario La Paz

Investigators

Study Director:	Robert M Kacmarek, PhD RRT FCCM	Massachusetts General Hospital
Principal Investigator:	Pedro de la Oliva, MD PhD	Hospital Universitario La Paz
Principal Investigator:	Jesus Villar, MD PhD	Hospital Universitario Dr. Negrin
Principal Investigator:	Demet Suleymanci, MD	Massachusetts General Hospital

More Information

Publications:

Beck J, Tucci M, Emeriaud G, Lacroix J, Sinderby C. Prolonged neural expiratory time induced by mechanical ventilation in infants. Pediatr Res. 2004 May;55(5):747-54. Epub 2004 Jan 22.

Spahija J, de Marchie M, Albert M, Bellemare P, Delisle S, Beck J, Sinderby C. Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med. 2010 Feb;38(2):518-26.

Breatnach C, Conlon NP, Stack M, Healy M, O'Hare BP. A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population. Pediatr Crit Care Med. 2010 Jan;11(1):7-11.

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

de la Oliva P, Schüffelmann C, Gómez-Zamora A, Villar J, Kacmarek RM. Asynchrony, neural drive, ventilatory variability and COMFORT: NAVA versus pressure support in pediatric patients. A non-randomized cross-over trial. Intensive Care Med. 2012 May;38(5):838-46. Epub 2012 Apr 6.

Responsible Party:	Pedro de la Oliva, Hospital Universitario La Paz
ClinicalTrials.gov Identifier:	NCT01159106 History of Changes
Other Study ID Numbers:	HULP-PI-3132
Study First Received:	July 8, 2010
Last Updated:	July 8, 2010
Health Authority:	Spain: Ethics Committee Spain: Ministry of Health and Consumption

Keywords provided by Hospital Universitario La Paz:

Positive Pressure Ventilation
Neurally Adjusted Ventilatory Assist
Patient/ventilator Asynchrony
Pediatric patient
Infant

ClinicalTrials.gov processed this record on May 22, 2013

The Use of Neurally Adjusted Ventilatory Assist (NAVA) Versus Pressure Support During Asynchrony in Children (NAVAChildren)