Respiratory Failure Clinical Trial
Official title:
Assessment of Patient-ventilator Breath Contribution (PVBC) During Neurally Adjusted Ventilatory Assist (NAVA) in Patients With Acute Respiratory Failure
The primary purpose of mechanical ventilation is to sufficiently unload the respiratory
muscles and maintain adequate ventilation in spontaneously breathing patients. When the
mechanical ventilatory assist is synchronized to the patient's inspiratory effort, both the
patient and the mechanical ventilator will contribute to the lung-distending pressure,
necessary to overcome inspiratory load and generate the tidal volume (Vt). Unfortunately,
conventional modes of mechanical ventilation cannot quantify the impact of the ventilatory
assist performed by the ventilator and the patient. Inadequate levels of assist are
associated with adverse effects such as development of fatigue or patient-ventilator
dissynchrony and diaphragm impairment, and over assist also lead to diaphragm atrophy and
weaning delay.
The newly introduced neurally adjusted ventilatory assist (NAVA) has made it possible to
measure the neural activity of the respiratory centers (expressed by the diaphragm
electrical activity, EAdi). EAdi is a validated variable to quantify the neural respiratory
drive, little is known about its usefulness to evaluate the contribution of the patient's
inspiratory muscle effort relative to that of the mechanical ventilator, which would be of
crucial importance to appropriately titrate the level of assist.
During NAVA, the patient's efficiency to transform neural effort (EAdi) into Vt, expressed
as neuroventilatory efficiency (NVE), may be a useful predictor for determining the
contribution of the patient and the ventilator to generate a breath.
n/a
Observational Model: Case-Only, Time Perspective: Prospective
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