Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference
Por:
Terzi, N, Piquilloud, L, Roze, H, Mercat, A, Lofaso, F, Delisle, S, Jolliet, P, Sottiaux, T, Tassaux, D, Roesler, J, Demoule, A, Jaber, S, Mancebo, J, Brochard, L, Richard, JCM
Publicada:
1 ene 2012
Resumen:
Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe. In clinical settings, NAVA has been chiefly compared with pressure-support ventilation, one of the most popular modes used during the weaning phase, which delivers a constant pressure from breath to breath. Comparisons with proportional-assist ventilation, which has numerous similarities, are lacking. Because of the constant level of assistance, pressure-support ventilation reduces the natural variability of the breathing pattern and can be associated with asynchrony and/or overinflation. The ability of NAVA to circumvent these limitations has been addressed in clinical studies and is discussed in this report. Although the underlying concept is fascinating, several important questions regarding the clinical applications of NAVA remain unanswered. Among these questions, determining the optimal NAVA settings according to the patient's ventilatory needs and/or acceptable level of work of breathing is a key issue. In this report, based on an investigator-initiated round table, we review the most recent literature on this topic and discuss the theoretical advantages and disadvantages of NAVA compared with other modes, as well as the risks and limitations of NAVA.
Filiaciones:
Terzi, N:
INSERM, U1075, F-14000 Caen, France
Univ Caen, F-14000 Caen, France
CHRU Caen, Serv Reanimat Med, F-14000 Caen, France
Piquilloud, L:
Lausanne Univ Hosp CHUV, Adult Intens Care & Burn Unit, CH-1011 Lausanne, Switzerland
Roze, H:
Bordeaux Univ Hosp, Dept Anaesthesiol & Intens Care 2, F-33000 Bordeaux, France
Mercat, A:
France Univ Angers, LUNAM Univ, CHU Angers, Med ICU, F-49933 Angers 09, France
Univ Angers, CHU Angers, F-49933 Angers, France
Lofaso, F:
Univ Versailles, Ctr Invest Clin Innovat Technol, Serv Physiol Explorat Fonct, Hop Raymond Poincare,AP HP,EA 4497, F-92380 Garches, France
INSERM, U955, F-94000 Creteil, France
Delisle, S:
Hop Sacre Coeur, Montreal, PQ H4J 1C5, Canada
Jolliet, P:
Lausanne Univ Hosp CHUV, Adult Intens Care & Burn Unit, CH-1011 Lausanne, Switzerland
Sottiaux, T:
Gosselies Hosp, Intens Care Unit, Clin Notre Dame Grace, B-6041 Gosselies, Belgium
Tassaux, D:
Lausanne Univ Hosp CHUV, Adult Intens Care & Burn Unit, CH-1011 Lausanne, Switzerland
Roesler, J:
St Luc Univ Hosp, Intens Care Unit, B-1200 Brussels, Belgium
Demoule, A:
Univ Paris 06, Med Intens Care Unit, Grp Hosp Pitie Salpetriere, Paris, France
Univ Paris 06, Div Resp, Grp Hosp Pitie Salpetriere, Paris, France
INSERM974, Paris, France
Jaber, S:
Univ Montpellier, INSERM, U1046, F-34295 Montpellier, France
St Eloi Univ Hosp, Dept Crit Care Med & Anesthesiol DAR B, F-34295 Montpellier, France
Mancebo, J:
Hosp St Pau C, Intens Care Unit, Barcelona 08041, Spain
Brochard, L:
INSERM, U955, F-94000 Creteil, France
Univ Geneva, Univ Hosp Geneva, Sch Med, Intens Care Unit, CH-1205 Geneva, Switzerland
Richard, JCM:
Univ Geneva, Univ Hosp Geneva, Sch Med, Intens Care Unit, CH-1205 Geneva, Switzerland
Univ Hosp, Med Intens Care Unit, F-76000 Rouen, France
UPRES EA3830, Rouen, France
Gold, Green Published
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