Neurally adjusted ventilatory assist in ventilated very preterm infants: A crossover study

Objective: To assess the effects of neurally adjusted ventilatory assist (NAVA) ventilation on oxygenation and respiratory parameters in preterm infants. Study Design: An observational crossover study with a convenience sample of 19 infants born before 30 gestational weeks. Study parameters were recorded during 3-h periods of both NAVA and conventional ventilation. The proportion of time peripheral oxygen saturation (SpO₂) and cerebral regional oxygen saturation (cRSO₂) were within their target ranges, plus the number and severity of desaturation episodes were analyzed. In addition, electrical activity of the diaphragm (Edi), neural respiratory rates, and peak inspiratory pressures (PIPs) were recorded. Results: Infants were born at a median age of 26^4/7 gestational weeks (range: 23^0/7–29^3/7); the study was performed at a median age of 20 days (range: 1–82). The proportion of time SpO₂ was within the target range, the number of peripheral desaturations or cRSO₂ did not differ between the modes. However, the desaturation severity index was lower (131 vs. 152; p =.03) and fewer manual supplemental oxygen adjustments (1.3 vs. 2.2/h; p =.006) were needed during the period of NAVA ventilation following conventional ventilation. The mean Edi (8.1 vs. 11.4 µV; p <.006) and PIP values (14.9 vs. 19.1; p <.001) were lower during the NAVA mode. Conclusions: Although NAVA ventilation did not increase the proportion of time with optimal saturation, it was associated with decreased diaphragmatic activity, lower PIPs, less severe hypoxemic events, and fewer manual oxygen adjustments in very preterm infants.