Neurally adjusted ventilatory assist for children on veno-venous ECMO.

Child, Preschool; Diaphragm/physiology; Extracorporeal Membrane Oxygenation/statistics & numerical data; Female; Humans; Infant; Interactive Ventilatory Support; Lung; Male; Respiration, Artificial; Respiratory Distress Syndrome, Newborn/therapy; Respiratory Function Tests; Respiratory Insufficiency/therapy; Retrospective Studies; Tidal Volume; ARDS; ECMO; Extracorporeal membrane oxygenation; NAVA; Veno-venous; Ventilatory assist

Abstract :

[en] NAVA may improve veno-venous ECMO weaning in children. This is a retrospective small series, describing for the first time proof-of-principle for the use of NAVA in children on VV ECMO. Six patients (age 1-48 months) needed veno-venous ECMO. Controlled conventional ventilation was replaced with assisted ventilation as soon as lung compliance improved, and could trigger initiation and termination of ventilation. NAVA was then initiated when diaphragmatic electrical activity (EAdi) allowed for triggering. NAVA was possible in all patients. Proportionate to EAdi (1.8-26 μV), initial peak inspiratory pressures ranged from 21 to 34 cm H(2)O, and the tidal volume (Vt) from 3 to 7 ml/kg. During weaning, peak pressures increased proportionally to EAdi increase (5.2-41 μV), with tidal volumes ranging from 6.6 to 8.6 ml/kg. ECMO was weaned after a median time of 1.75 days on NAVA. Following ECMO weaning, the median duration of mechanical ventilation, and intensive care unit stay were 4.5 days, and 13.5 days, respectively. Survival to hospital discharge was 100%. In conclusion, combining NAVA to ECMO in paediatric respiratory failure is safe and feasible, and may help in a smoother ECMO weaning, since NAVA allows the patient to drive the ventilator and regulate Vt according to needs.

Disciplines :

Anesthesia & intensive care

Author, co-author :

ASSY, Jana ; Centre Hospitalier Universitaire de Liège - CHU > Département de Pédiatrie > Service de pédiatrie

Mauriat, Philippe

Tafer, Nadir

Soulier, Sylvie

El Rassi, Issam

Language :

English

Title :

Neurally adjusted ventilatory assist for children on veno-venous ECMO.

Publication date :

2019

Journal title :

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs

ISSN :

1434-7229

eISSN :

1619-0904

Volume :

Issue :

Pages :

118-125

Peer reviewed :

Peer reviewed

Commentary :

Epub 2019 Jan 4.

Available on ORBi :

since 15 February 2022

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Bibliography

Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilator support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicenter randomized controlled trial. Lancet. 2009;374:1351–63.
Schmidt M, Pellegrino V, Coombes A, et al. Mechanical ventilation during membrane oxygenation. Crit Care. 2014;18:203–10.
Maslach-Hubbard A, Bratton SL. Extracorporeal membrane oxygenation for pediatric respiratory failure: history, development and current status. World J Crit Care Med. 2013;2:29–39.
Schmidt M, Steart C, Bailey M, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43:654–64.
Pediatric Acute Lung Injury Consensus Conference Group. Pediatic acute respiratory distress syndrome: consensus recommendation from the pediatric acute lung injury consensus conference. Pediatr Crit Care. 2015;16:428–439.
Kneyber M, Jouvet P, Rimensberger P. How to manage ventilation in pediatric acute respiratory distress syndrome. Intensive Care Med. 2014;40:1924–6.
Richard C, Argaud L, Blet A, et al. Extracorporeal life support for patients with acute respiratory distress syndrome (adult and paediatric). Consensus conference organized by the French Intensive Care Society. Rev Mal Respir. 2014;31:779–795.
Huh JW. Update on the extracorporeal life support. Tuberc Resp Dis. 2015;78:149–55.
Zhang Z, Gu WJ, Chen K, et al. Mechanical ventilation during extracorporeal membrane oxygenation in patients with acute severe respiratory failure. Can Respir J 2017. 10.1155/2017/1783857. (Epub 2017).
Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–16.
Forel JM, Roch A, Marin V, et al. Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome. Critical Care Med. 2006;34:2749–57.
Powers SK, Kavazis AN, Levine S. Prolonged mechanical ventilation alters diaphragmatic structure and function. Crit Care Med. 2009;37:347–53.
Karagiannidis C, Lubnow M, Philipp A, et al. Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med. 2010;36:2038–44.
Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008;358:1327–35.
Vassilakopoulos T, Zakynthinos S, Roussos C. Bench-to-bedside review: weaning failure—should we rest the respiratory muscles with controlled mechanical ventilation? Crit Care. 2006;10:204–9.
Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.
Yoshida T, Rinka H, Kaji A, et al. The impact of spontaneous ventilation on distribution of lung aeration in patients with acute respiratory distress syndrome: airway pressure release ventilation versus pressure support ventilation. Anesth Analg. 2009;109:1892–900.
Putensen C, Mutz NJ, Putensen-Himmer G, et al. Spontaneous breathing during ventilatory support improves ventilation–perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999;159:1241–8.
Sinderby C. Ventilatory assist driven by patient demand. Am J Respir Crit Care Med. 2003;168:720–30.
Lellouche F, Brochard L. Advanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare). Best Pract Res Clin Anaesthesiol. 2009;23:81–93.
Beck J, Reilly M, Grasselli G, et al. Patient–ventilator interaction during neurally adjusted ventilatory assist in very low birth weight infants. Pediatr Res. 2009;65:663–8.
Barwing J, Ambold M, Linden N, et al. Evaluation of the catheter positioning for neurally adjusted ventilatory assist. Intensive Care Med. 2009;35:1809–14.
Colombo D, Cammarota G, Bergamaschi V, et al. Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med. 2008;34:2010–8.
Bein T, Osborn E, Hofmann HS, et al. Successful treatment of a severely injured soldier from Afghanistan with pumpless extracorporeal lung assist and neurally adjusted ventilatory support. Int J Emerg Med. 2010;3:177–9.
Mauri T, Bellani G, Grasselli G, et al. Patient–ventilator interaction in ARDS patients with extremely low compliance undergoing ECMO: a novel approach based on diaphragm electrical activity. Intensive Care Med. 2013;39:282–91.
Brogan T, Lequier L, Lorusso R, MacLaren G, Peek G. ECMO: extracorporeal cardiopulmonary support in critical care, Red book. 5th ed. Ann Arbor: Extracorporeal Life Support Organization; 2017.
Putensen C, Hering R, Muders T, et al. Assisted breathing is better in acute respiratory failure. Curr Opin Crit Care. 2005;11:63–8.
Putensen C, Zech S, Wrigge H, et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001;164:43–9.
Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995;332:345–50.
Güldner A, Kiss T, Bluth T, et al. Effects of ultraprotective ventilation, extracorporeal carbon dioxide removal, and spontaneous breathing on lung morphofunction and inflammation in experimental severe acute respiratory distress syndrome. Anesthesiology. 2015;122:631–46.
Hering R, Bolten JC, Kreyer S, et al. Spontaneous breathing during airway pressure release ventilation in experimental lung injury: effects on hepatic blood flow. Intensive Care Med. 2008;34:523–7.
Goto Y, Katayama S, Shono A, Mori Y, Miyazaki Y, Sato Y, Ozaki M, Kotani T. Roles of NAVA in improving gaz exchange in a severe acute respiratory distress syndrome patient after weaning from ECMO: a case report. J Intensive Care. 2016;4:21–31.
De Wit M, Miller KB, Green DA, et al. Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med. 2009;37:2740–5.
Richard JC, Lefebvre JC, Tassaux D, et al. Update in mechanical ventilation 2010. Am J Respir Crit Care Med. 2011;184:32–6.
Piquilloud L, Vignaux L, Bialais E, et al. Neurally adjusted ventilatory assist improves patient–ventilator interaction. Intensive Care Med. 2011;37:263–71.
Epstein SK. How often does patient–ventilator asynchrony occur and what are the consequences? Respir Care. 2011;56:25–35.
Di Mussi R, Spadaro S, Mirabella L, et al. Impact of prolonged assisted ventilation on diaphragmatic efficiency; NAVA versus PSV. Crit Care. 2016;20:1–12.
Kolobow T, Gattinoni L, Tomlinson TA, et al. Control of breathing using an extracorporeal membrane lung. Anesthesiology. 1977;46:138–41.
Brander L, Sinderby C, Lecomte F, et al. Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury. Intensive Care Med. 2009;35:1979–89.