• Michelle L Jones, Shasha Bai, Tracy L Thurman, Shirley J Holt, Mark J Heulitt, and Sherry E Courtney.
• Section of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
• Respir Care. 2018 Dec 1; 63 (12): 1478-1484.

BackgroundNoninvasive ventilation (NIV) is commonly used in neonates. A mode of NIV called neurally adjusted ventilatory assist (NAVA) offers patient-ventilator interactions by using electrical activity of the diaphragm to control mechanical breaths. We hypothesized that the work of breathing (WOB) would decrease with NIV-NAVA. Secondary objectives evaluated the impact of NIV-NAVA on arterial blood gases and respiratory parameters.MethodsWe compared WOB between synchronized breaths in NIV-NAVA and NIV in piglets with healthy lungs and then with surfactant-depleted lungs. Neonatal pigs (median, 2.0 [range, 1.8-2.4] kg) with healthy and then surfactant depleted lungs were sedated and ventilated with NIV-NAVA and NIV in random order. Airway flow and pressure waveforms were acquired. Waveforms were analyzed for the pressure-time product that reflected WOB. The primary outcome between modes was assessed with repeated measurement analysis of variance.ResultsThe pressure-time product was significantly decreased for NIV-NAVA in both healthy and injured lungs (P < .001). PaO2 , PaCO2 , inspiratory tidal volume, and peak inspiratory flow were not different in either model.ConclusionsSynchronized breaths during NIV-NAVA resulted in decreased WOB compared with synchronized breaths during NIV.Copyright © 2018 by Daedalus Enterprises.

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