Optimisation of Neonatal Ventilation - NAVA vs PAV
Research type
Research Study
Full title
Optimisation of Neonatal Ventilation - NAVA vs PAV
IRAS ID
210450
Contact name
Anne Greenough
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
1 years, 5 months, 1 days
Research summary
Despite improvements in survival rates of extremely preterm born infants, the incidence of bronchopulmonary dysplasia (BPD) remains unchanged over the last two decades. As invasive ventilation is frequently necessary and indeed life-saving, numerous ventilator strategies have been developed to reduce damage to the developing lung.
Conventional ventilation allows the clinician to set the inspiratory pressure or tidal volume delivered by the ventilator. The appropriateness of this target is then assessed via blood gas analysis and adjusted as necessary with changes in respiratory system mechanics and patient condition.
Recently, novel modes of ventilation have been introduced that aim to improve upon conventional ventilation. During both proportional assist ventilation (PAV) and neurally-adjusted ventilatory assist (NAVA), respiratory support is servo-controlled based on continuous input from the baby’s respiratory effort. Both aim to improve synchronization of the timing of the respiratory cycle and also to vary the level of support offered breath-to-breath in proportion to the respiratory effort of the patient.
During PAV the ventilator can vary inflation pressure in phase with both volume change and flow change in order to offload both elastic and resistive components of the work of breathing.
NAVA utilises the electrical activity of the diaphragm, sensed via a specialized feeding tube, to trigger the ventilator and determine the level of support given at every stage during a breath.
Both PAV and NAVA have been shown to have advantages above conventional triggered ventilation in neonates, but they have not been compared to each other. Our aim is to determine whether NAVA or PAV is more effective in reducing oxygenation index, work of breathing, and thoracoabdominal asynchrony in prematurely born neonates with evolving or established BPD.
REC name
London - South East Research Ethics Committee
REC reference
16/LO/1660
Date of REC Opinion
19 Oct 2016
REC opinion
Further Information Favourable Opinion