Noninvasive Neurally Adjusted Ventilatory Assist Versus High Flow Cannula Support After Congenital Heart Surgery.

BACKGROUND: Extubation failure rates for critical patients in pediatric intensive care units (ICUs) range from 5% to 29%. Noninvasive (NIV) ventilation has been shown to decrease extubation failure. We compared reintubation rates and outcomes of patients supported with NIV neurally adjusted ventilation assist (NAVA) versus historical controls supported with high-flow nasal cannula (HFNC). METHODS: Case-control study of infants less than three months of age who underwent cardiac surgery and received NIV support after extubation from January 2011 to May 2017. All patients supported with NIV NAVA after it became available in September 2013 were compared to matched patients extubated to HFNC from prior to September 2013. RESULTS: Forty-two patients identified for the NIV NAVA group were matched with 42 historical controls supported with HFNC. Groups had similar baseline characteristics based on rate of acute kidney injury, number of single ventricle patients, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, age, weight, bypass time, and duration of intubation. There was no significant difference in reintubation rates within 72 hours (14.3% in the HFNC group and 16.7% in the NIV NAVA group, P = 1.0). Median duration from extubation to coming off NIV support was longer in the NIV NAVA group (3.6 days vs 0.6 days, P < .001). Median time from extubation to ICU discharge was longer in the NIV NAVA group (10.5 vs 6.8 days, P = .02), as was total postoperative ICU length of stay (LOS; 17.6 vs 12.2, P = .01). CONCLUSIONS: Introduction of NIV NAVA for postextubation support did not reduce reintubation rates compared to HFNC. Further study is needed as adoption of NIV NAVA may prolong LOS.

Utilization of Neurally Adjusted Ventilatory Assist (NAVA) Mode in Infants and Children Undergoing Congenital Heart Surgery: A Retrospective Review.

We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. The ventilatory and gas exchange parameters for the 24 h pre- and post-transition to NAVA were compared. Additional parameters assessed included pain scores and sedation requirements. Eighty-one patients met inclusion criteria with a median age of 21 days (interquartile range 13 days-2 months). The majority of patients enrolled (75.3%) had complex congenital heart disease with high surgical severity scores. The transition to NAVA was tolerated by all patients without complications. The mean peak inspiratory pressure (PIP) was 1.8 cm H2O lower (p < 0.001) and mean airway pressure (Paw) was 0.5 cm H2O lower (p = 0.009) on NAVA compared to conventional modes of mechanical ventilation. There was no significant difference in patients' respiratory rate, tidal volume, arterial pH, pCO2, and lactate levels between the two modes of ventilation. There was a decreased sedation requirement during the time of NAVA ventilation. Comfort scores did not differ significantly with ventilator mode change. We concluded that NAVA is safe and well-tolerated mode of mechanical ventilation for our cohort of patients after congenital heart surgery. Compared to conventional ventilation there was a statistically significant decrease in PIP and Paw on NAVA.