Impact of ventilatory modes on the breathing variability in mechanically ventilated infants.
Objectives: Reduction of breathing variability is associated with adverse outcome. During mechanical ventilation, the variability of ventilatory pressure is dependent on the ventilatory mode. During neurally adjusted ventilatory assist (NAVA), the support is proportional to electrical activity of di...
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doaj-56bf7d1f871741dfbb9a321626cf5c762020-11-24T23:37:46ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602014-11-01210.3389/fped.2014.00132113034Impact of ventilatory modes on the breathing variability in mechanically ventilated infants.Florent eBAUDIN0Hau-Tieng eWU1Alice eBORDESSOULE2Jennifer eBECK3Jennifer eBECK4Philippe eJOUVET5Martin eFRASCH6Martin eFRASCH7Guillaume eEMERIAUD8CHU Sainte-Justine, Université de MontrealUniversity of TorontoGeneva University HospitalUniversity of TorontoSt. Michael’s HospitalCHU Sainte-Justine, Université de MontrealCHU Ste-Justine Research Center, Université de MontréalUniversité de MontrealCHU Sainte-Justine, Université de MontrealObjectives: Reduction of breathing variability is associated with adverse outcome. During mechanical ventilation, the variability of ventilatory pressure is dependent on the ventilatory mode. During neurally adjusted ventilatory assist (NAVA), the support is proportional to electrical activity of diaphragm (EAdi), which reflects the respiratory center output. The variability of EAdi is therefore translated into a similar variability in pressures. Contrastingly, conventional ventilatory modes deliver less variable pressures. The impact of the mode on the patient’s own respiratory drive is less clear. This study aims to compare the impact of NAVA, pressure-control (PCV) and pressure-support ventilation (PSV) on the respiratory drive patterns in infants. We hypothesized that on NAVA, EAdi variability resembles most the endogenous respiratory drive pattern seen in a control group.Methods: EAdi was continuously recorded in 10 infants ventilated successively on NAVA (5 hours), PCV (30 min), and PSV (30 min). During the last 10 minutes of each period, the EAdi variability pattern was assessed using non-rhythmic to rhythmic index (NRR). These variability profiles were compared to the pattern of a control group of 11 spontaneously breathing and non-intubated infants.Results: In control infants, NRR was higher as compared to mechanically ventilated infants (p<0.001), and NRR pattern was relatively stable over time. While the temporal stability of NRR was similar in NAVA and controls, the NRR profile was less stable during PCV. PSV exhibited an intermediary pattern. Perspectives: Mechanical ventilation impacts the breathing variability in infants. NAVA produces EAdi pattern resembling most that of control infants. NRR can be used to characterize respiratory variability in infants. Larger prospective studies are necessary to understand the differential impact of the ventilatory modes on the cardio-respiratory variability and to study their impact on clinical outcomes.http://journal.frontiersin.org/Journal/10.3389/fped.2014.00132/fullInfantmechanical ventilationneurally adjusted ventilatory assistbreathing variabilitynon-rhythmic to rhythmic indexelectrical activity of diaphragm |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Florent eBAUDIN Hau-Tieng eWU Alice eBORDESSOULE Jennifer eBECK Jennifer eBECK Philippe eJOUVET Martin eFRASCH Martin eFRASCH Guillaume eEMERIAUD |
spellingShingle |
Florent eBAUDIN Hau-Tieng eWU Alice eBORDESSOULE Jennifer eBECK Jennifer eBECK Philippe eJOUVET Martin eFRASCH Martin eFRASCH Guillaume eEMERIAUD Impact of ventilatory modes on the breathing variability in mechanically ventilated infants. Frontiers in Pediatrics Infant mechanical ventilation neurally adjusted ventilatory assist breathing variability non-rhythmic to rhythmic index electrical activity of diaphragm |
author_facet |
Florent eBAUDIN Hau-Tieng eWU Alice eBORDESSOULE Jennifer eBECK Jennifer eBECK Philippe eJOUVET Martin eFRASCH Martin eFRASCH Guillaume eEMERIAUD |
author_sort |
Florent eBAUDIN |
title |
Impact of ventilatory modes on the breathing variability in mechanically ventilated infants. |
title_short |
Impact of ventilatory modes on the breathing variability in mechanically ventilated infants. |
title_full |
Impact of ventilatory modes on the breathing variability in mechanically ventilated infants. |
title_fullStr |
Impact of ventilatory modes on the breathing variability in mechanically ventilated infants. |
title_full_unstemmed |
Impact of ventilatory modes on the breathing variability in mechanically ventilated infants. |
title_sort |
impact of ventilatory modes on the breathing variability in mechanically ventilated infants. |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pediatrics |
issn |
2296-2360 |
publishDate |
2014-11-01 |
description |
Objectives: Reduction of breathing variability is associated with adverse outcome. During mechanical ventilation, the variability of ventilatory pressure is dependent on the ventilatory mode. During neurally adjusted ventilatory assist (NAVA), the support is proportional to electrical activity of diaphragm (EAdi), which reflects the respiratory center output. The variability of EAdi is therefore translated into a similar variability in pressures. Contrastingly, conventional ventilatory modes deliver less variable pressures. The impact of the mode on the patient’s own respiratory drive is less clear. This study aims to compare the impact of NAVA, pressure-control (PCV) and pressure-support ventilation (PSV) on the respiratory drive patterns in infants. We hypothesized that on NAVA, EAdi variability resembles most the endogenous respiratory drive pattern seen in a control group.Methods: EAdi was continuously recorded in 10 infants ventilated successively on NAVA (5 hours), PCV (30 min), and PSV (30 min). During the last 10 minutes of each period, the EAdi variability pattern was assessed using non-rhythmic to rhythmic index (NRR). These variability profiles were compared to the pattern of a control group of 11 spontaneously breathing and non-intubated infants.Results: In control infants, NRR was higher as compared to mechanically ventilated infants (p<0.001), and NRR pattern was relatively stable over time. While the temporal stability of NRR was similar in NAVA and controls, the NRR profile was less stable during PCV. PSV exhibited an intermediary pattern. Perspectives: Mechanical ventilation impacts the breathing variability in infants. NAVA produces EAdi pattern resembling most that of control infants. NRR can be used to characterize respiratory variability in infants. Larger prospective studies are necessary to understand the differential impact of the ventilatory modes on the cardio-respiratory variability and to study their impact on clinical outcomes. |
topic |
Infant mechanical ventilation neurally adjusted ventilatory assist breathing variability non-rhythmic to rhythmic index electrical activity of diaphragm |
url |
http://journal.frontiersin.org/Journal/10.3389/fped.2014.00132/full |
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