神经调节通气辅助和比例辅助通气均能改善患者与呼吸机的相互作用。
Neurally adjusted ventilatory assist and proportional assist ventilation both improve patient-ventilator interaction.
作者信息
Schmidt Matthieu, Kindler Felix, Cecchini Jérôme, Poitou Tymothée, Morawiec Elise, Persichini Romain, Similowski Thomas, Demoule Alexandre
机构信息
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.
INSERM, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.
出版信息
Crit Care. 2015 Feb 25;19(1):56. doi: 10.1186/s13054-015-0763-6.
INTRODUCTION
The objective was to compare the impact of three assistance levels of different modes of mechanical ventilation; neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV), and pressure support ventilation (PSV) on major features of patient-ventilator interaction.
METHODS
PSV, NAVA, and PAV were set to obtain a tidal volume (VT) of 6 to 8 ml/kg (PSV₁₀₀, NAVA₁₀₀, and PAV₁₀₀) in 16 intubated patients. Assistance was further decreased by 50% (PSV₅₀, NAVA₅₀, and PAV₅₀) and then increased by 50% (PSV₁₅₀, NAVA₁₅₀, and PAV₁₅₀) with all modes. The three modes were randomly applied. Airway flow and pressure, electrical activity of the diaphragm (EAdi), and blood gases were measured. VT, peak EAdi, coefficient of variation of VT and EAdi, and the prevalence of the main patient-ventilator asynchronies were calculated.
RESULTS
PAV and NAVA prevented the increase of VT with high levels of assistance (median 7.4 (interquartile range (IQR) 5.7 to 10.1) ml/kg and 7.4 (IQR, 5.9 to 10.5) ml/kg with PAV₁₅₀ and NAVA₁₅₀ versus 10.9 (IQR, 8.9 to 12.0) ml/kg with PSV₁₅₀, P <0.05). EAdi was higher with PAV than with PSV at level₁₀₀ and level₁₅₀. The coefficient of variation of VT was higher with NAVA and PAV (19 (IQR, 14 to 31)% and 21 (IQR 16 to 29)% with NAVA₁₀₀ and PAV₁₀₀ versus 13 (IQR 11 to 18)% with PSV₁₀₀, P <0.05). The prevalence of ineffective triggering was lower with PAV and NAVA than with PSV (P <0.05), but the prevalence of double triggering was higher with NAVA than with PAV and PSV (P <0.05).
CONCLUSIONS
PAV and NAVA both prevent overdistention, improve neuromechanical coupling, restore the variability of the breathing pattern, and decrease patient-ventilator asynchrony in fairly similar ways compared with PSV. Further studies are needed to evaluate the possible clinical benefits of NAVA and PAV on clinical outcomes.
TRIAL REGISTRATION
Clinicaltrials.gov NCT02056093 . Registered 18 December 2013.
引言
目的是比较三种不同机械通气模式（神经调节通气辅助（NAVA）、比例辅助通气（PAV）和压力支持通气（PSV））的三种辅助水平对患者 - 呼吸机相互作用主要特征的影响。
方法
对16例插管患者设置PSV、NAVA和PAV，使其潮气量（VT）达到6至8 ml/kg（PSV₁₀₀、NAVA₁₀₀和PAV₁₀₀）。所有模式下辅助水平进一步降低50%（PSV₅₀、NAVA₅₀和PAV₅₀），然后提高50%（PSV₁₅₀、NAVA₁₅₀和PAV₁₅₀）。这三种模式随机应用。测量气道流量和压力、膈肌电活动（EAdi）以及血气。计算VT、EAdi峰值、VT和EAdi的变异系数以及主要患者 - 呼吸机不同步的发生率。
结果
PAV和NAVA可防止高辅助水平下VT增加（PAV₁₅₀和NAVA₁₅₀时VT中位数为7.4（四分位间距（IQR）5.7至10.1）ml/kg和7.4（IQR，5.9至10.5）ml/kg，而PSV₁₅₀时为10.9（IQR，8.9至12.0）ml/kg，P<0.05）。在100水平和150水平时，PAV时的EAdi高于PSV。NAVA和PAV时VT的变异系数更高（NAVA₁₀₀和PAV₁₀₀时分别为19（IQR，14至31）%和21（IQR 16至29）%，而PSV₁₀₀时为13（IQR 11至18）%，P<0.05）。PAV和NAVA时无效触发的发生率低于PSV（P<0.05），但NAVA时双重触发的发生率高于PAV和PSV（P<0.05）。
结论
与PSV相比，PAV和NAVA均能防止过度扩张，改善神经机械耦合，恢复呼吸模式的变异性，并以相当相似的方式减少患者 - 呼吸机不同步。需要进一步研究评估NAVA和PAV对临床结局可能的临床益处。
试验注册
Clinicaltrials.gov NCT02056093。2013年12月18日注册。
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