Noninvasive ventilation through a helmet in postextubation hypoxemic patients: Physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation

Purpose: Neurally adjusted ventilatory assist (NAVA) has been shown to improve patient-ventilator interaction and reduce asynchronies in intubated patients, as opposed to pressure support ventilation (PSV). This is a short-term head-to-head physiologic comparison between PSV and NAVA in delivering noninvasive ventilation through a helmet (h-NIV), in patients with postextubation hypoxemic acute respiratory failure. Methods: Ten patients underwent three 20-min trials of h-NIV in PSV, NAVA, and PSV again. Arterial blood gases (ABGs) were assessed at the end of each trial. Diaphragm electrical activity (EAdi) and airway pressure (P aw) were recorded to derive neural and mechanical respiratory rate and timing, inspiratory (delay TR-insp) and expiratory trigger delays (delay TR-exp), time of synchrony between diaphragm contraction and ventilator assistance (time synch), and the asynchrony index (AI). Results: ABGs, peak EAdi, peak P aw, respiratory rate, either neural or mechanical, neural timing, and delay TR-exp were not different between trials. Compared with PSV, with NAVA the mechanical expiratory time was significantly shorter, while the inspiratory time and duty cycle were greater. Time synch was 0.79 ± 0.35 s in NAVA versus 0.60 ± 0.30 s and 0.55 ± 0.29 s during the PSV trials (p < 0.01 for both). AI exceeded 10% during both PSV trials, while not in NAVA (p < 0.001). Conclusions: Compared with PSV, NAVA improves patient-ventilator interaction and synchrony, with no difference in gas exchange, respiratory rate, and neural drive and timing.