Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modesReportar como inadecuado

Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Annals of Intensive Care

, 1:42

First Online: 28 September 2011Received: 17 May 2011Accepted: 28 September 2011


BackgroundMechanical ventilation seems to occupy a major source in alteration in the quality and quantity of sleep among patients in intensive care. Quality of sleep is negatively affected with frequent patient-ventilator asynchronies and more specifically with modes of ventilation. The quality of sleep among ventilated patients seems to be related in part to the alteration between the capacities of the ventilator to meet patient demand. The objective of this study was to compare the impact of two modes of ventilation and patient-ventilator interaction on sleep architecture.

MethodsProspective, comparative crossover study in 14 conscious, nonsedated, mechanically ventilated adults, during weaning in a university hospital medical intensive care unit. Patients were successively ventilated in a random ordered cross-over sequence with neurally adjusted ventilatory assist NAVA and pressure support ventilation PSV. Sleep polysomnography was performed during four 4-hour periods, two with each mode in random order.

ResultsThe tracings of the flow, airway pressure, and electrical activity of the diaphragm were used to diagnose central apneas and ineffective efforts. The main abnormalities were a low percentage of rapid eye movement REM sleep, for a median 25th-75th percentiles of 11.5% range, 8-20% of total sleep, and a highly fragmented sleep with 25 arousals and awakenings per hour of sleep. Proportions of REM sleep duration were different in the two ventilatory modes 4.5% range, 3-11% in PSV and 16.5% range, 13-29% during NAVA p = 0.001, as well as the fragmentation index, with 40 ± 20 arousals and awakenings per hour in PSV and 16 ± 9 during NAVA p = 0.001. There were large differences in ineffective efforts 24 ± 23 per hour of sleep in PSV, and 0 during NAVA and episodes of central apnea 10.5 ± 11 in PSV vs. 0 during NAVA. Minute ventilation was similar in both modes.

ConclusionsNAVA improves the quality of sleep over PSV in terms of REM sleep, fragmentation index, and ineffective efforts in a nonsedated adult population.

Electronic supplementary materialThe online version of this article doi:10.1186-2110-5820-1-42 contains supplementary material, which is available to authorized users.

Download fulltext PDF

Autor: Stéphane Delisle - Paul Ouellet - Patrick Bellemare - Jean-Pierre Tétrault - Pierre Arsenault


Documentos relacionados