Utilization of Neurally Adjusted Ventilatory Assist (NAVA) Mode in Infants and Children Undergoing Congenital Heart Surgery: A Retrospective Review

Nathanya Baez Hernandez, Abdulhamid Milad, Yi Li, Andrew H. Van Bergen

Research output: Contribution to journalArticle

Abstract

We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. The ventilatory and gas exchange parameters for the 24 h pre- and post-transition to NAVA were compared. Additional parameters assessed included pain scores and sedation requirements. Eighty-one patients met inclusion criteria with a median age of 21 days (interquartile range 13 days–2 months). The majority of patients enrolled (75.3%) had complex congenital heart disease with high surgical severity scores. The transition to NAVA was tolerated by all patients without complications. The mean peak inspiratory pressure (PIP) was 1.8 cm H 2 O lower (p < 0.001) and mean airway pressure (P aw ) was 0.5 cm H 2 O lower (p = 0.009) on NAVA compared to conventional modes of mechanical ventilation. There was no significant difference in patients’ respiratory rate, tidal volume, arterial pH, pCO 2 , and lactate levels between the two modes of ventilation. There was a decreased sedation requirement during the time of NAVA ventilation. Comfort scores did not differ significantly with ventilator mode change. We concluded that NAVA is safe and well-tolerated mode of mechanical ventilation for our cohort of patients after congenital heart surgery. Compared to conventional ventilation there was a statistically significant decrease in PIP and P aw on NAVA.

Original languageEnglish (US)
Pages (from-to)563-569
Number of pages7
JournalPediatric Cardiology
Volume40
Issue number3
DOIs
Publication statusPublished - Mar 15 2019
Externally publishedYes

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Keywords

  • Congenital heart surgery
  • Diaphragm activity
  • Mechanical ventilation
  • Neurally adjusted ventilatory assist
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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