Application of neurally adjusted ventilatory assist in the weaning from prolonged mechanical ventilation in pediatrics / 中华实用儿科临床杂志

ABSTRACT

Objective:To investigate the clinical effect of neurally adjusted ventilatory assist (NAVA)on weaning from prolonged mechanical ventilation (PMV) in pediatrics and its influence on related parameters of respiratory mechanics.Methods:A retrospective analysis was conducted on 12 children in the pediatric intensive care unit (PICU) of Children′s Hospital, Capital Institute of Pediatrics from July 2014 to July 2020.All the cases adopted NAVA for weaning from PMV, and the type of NAVA included invasive NAVA and non-invasive neurally adjusted ventilatory assist with NAVA.The main diagnosis, etiology, oxygenation index (OI), pediatric critical illness score (PCIS), treatment of mechanical ventilation(MV), respiratory mechanics indexes, length of stay in PICU and prognosis were recorded.Besides, the complications that happened after transition to NAVA were evaluated.The rank sum test was used for comparison of respiratory mechanics indexes and blood gas values before and after NAVA ventilation. Results:Among the 12 children, 11 cases had basic diseases.There were 8 premature infants complicated with chronic lung diseases.Two cases had Wilson-Mikity syndrome.One case had congenital omphalocele, 1 case had Prader-Willi syndrome (PWS), 1 case had spinal muscular atrophy (SMA). The main diagnosis of 8 children was acute respiratory distress syndrome (ARDS). The median duration of MV and PICU stay was 32.0 (25.0, 39.0) days and 39.5(29.5, 48.5) days.The median duration of invasive NAVA and non-invasive-NAVA was 5.5 (3.8, 6.3) days and 7.0(5.0, 9.5) days.All cases were successfully weaned from MV(100%), and the survival-to-discharge rate was 100%.There were no complications related to NAVA.After ventilation for 6 hours, no significant difference was observed in respiratory mechanical parameters between synchronized intermittent mandatory ventilation (SIMV) and NAVA (all P>0.05). However, compared with SIMV, NAVA significantly decreased the arterial partial pressure of carbon dioxide[43.50 (41.75, 46.00) mmHg vs.48.50 (45.25, 56.00) mmHg, 1 mmHg=0.133 kPa] ( Z=-2.253, P=0.024), increased the arterial partial pressure of oxygen[68.00 (65.00, 72.25) mmHg vs.62.00 (59.00, 64.75) mmHg] ( Z=-2.733, P=0.006), and reduced the value of OI[3.70 (3.38, 5.60) vs.5.90 (4.58, 7.08)]( Z=-2.272, P=0.023). Conclusions:NAVA is a safe and effective approach to weaning from PMV in children.Compared to SIMV, NAVA can greatly improve ventilation and oxygenation.NAVA is strongly recommended to PMV infants with chronic lung diseases who have failed to wean from ventilation.