Pediatr Pulmonol

. 2023 Feb 17.

 doi: 10.1002/ppul.26357. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36807570/

Respiratory physiology during NAVA ventilation in neonates born with a congenital diaphragmatic hernia: the “NAVA-diaph” pilot study

Lélia Dreyfus ¹, Marine Butin ^1 2, Frank Plaisant ¹, Olivier Claris ^1 3, Florent Baudin ^4 5

Affiliations expand

• PMID: 36807570
• DOI: 10.1002/ppul.26357

Abstract

Background: Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that delivers a synchronized ventilation, proportional to the electrical activity of the diaphragm (EAdi). Although it has been proposed in infants with congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm.

Aim: To evaluate, in a pilot study, the relationship between the respiratory drive (electrical activity of the diaphragm) and the respiratory effort in neonates with CDH during the post-surgical period under either NAVA ventilation or conventional ventilation (CV).

Methods: This prospective physiological study included 8 neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric and transdiaphragmatic pressure as well as clinical parameters were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the post-surgical period.

Results: EAdi was detectable and there was a correlation between the ΔEAdi (maximal – minimal values) and the transdiaphragmatic pressure (r= 0.26, 95%CI [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing.

Conclusion: Respiratory drive and effort was correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. EAdi can also be used to monitor diaphragm or for individualized support. This article is protected by copyright. All rights reserved.

Keywords: Congenital Diaphragmatic Hernia; NAVA Ventilation; Respiratory physiology; Transpulmonary pressure; Work of breathing.

This article is protected by copyright. All rights reserved.