Automated patient-ventilator interaction analysis during neurally adjusted non-invasive ventilation and pressure support ventilation in chronic obstructive pulmonary diseaseReport as inadecuate




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Critical Care

, 18:550

First Online: 13 October 2014Received: 11 June 2014Accepted: 22 September 2014

Abstract

IntroductionDelivering synchronous assist during non-invasive ventilation NIV is challenging with flow- or pressure-controlled ventilators, especially in patients with chronic obstructive pulmonary disease COPD. Neurally adjusted ventilatory assist NAVA uses diaphragm electrical activity EAdi to control the ventilator. We evaluated patient-ventilator interaction in patients with COPD during NIV with pressure support ventilation PSV and NAVA using a recently introduced automated analysis.

MethodsTwelve COPD patients underwent three 30-minute trials: 1 PSV with dedicated NIV ventilator NIV-PSVVision, 2 PSV with intensive care unit ICU ventilator NIV-PSVServo-I, and 3 with NIV-NAVA. EAdi, flow, and airway pressure were recorded. Patient-ventilator interaction was evaluated by comparing airway pressure and EAdi waveforms with automated computer algorithms. The NeuroSync index was calculated as the percentage of timing errors between airway pressure and EAdi.

ResultsThe NeuroSync index was higher larger error for NIV-PSVVision 24 IQR 15 to 30 % and NIV-PSVServo-I 21 IQR 15 to 26 % compared to NIV-NAVA 5 IQR 4 to 7 %; P <0.001. Wasted efforts, trigger delays and cycling-off errors were less with NAVA P <0.05 for all. The NeuroSync index and the number of wasted efforts were strongly correlated r = 0.84, with a drastic increase in wasted efforts after timing errors reach 20%.

ConclusionsIn COPD patients, non-invasive NAVA improves patient-ventilator interaction compared to PSV, delivered either by a dedicated or ICU ventilator. The automated analysis of patient-ventilator interaction allowed for an objective detection of patient-ventilator interaction during NIV. In addition, we found that progressive mismatch between neural effort and pneumatic timing is associated with wasted efforts.

AbbreviationsCOPDchronic obstructive pulmonary disease

EAdielectrical activity of the diaphragm

ICUintensive care unit

IQRinterquartile range

NAVAneurally adjusted ventilatory assist

NIVnon-invasive ventilation

Pawairway pressure

PEEPpositive end-expiratory pressure

PSVpressure support ventilation

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0550-9 contains supplementary material, which is available to authorized users.

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Author: Jonne Doorduin - Christer A Sinderby - Jennifer Beck - Johannes G van der Hoeven - Leo MA Heunks

Source: https://link.springer.com/







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