Performance of Neurally Adjusted Ventilatory Assist (NAVA) During an Spontaneous Breathing Trial
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Respiratory Failure
- Sponsor
- University of Sao Paulo General Hospital
- Enrollment
- 20
- Locations
- 1
- Primary Endpoint
- rate of success on the spontaneous breathing trial
- Status
- Completed
- Last Updated
- 12 years ago
Overview
Brief Summary
The purpose of this study is to compare a new mode of mechanical ventilation (NAVA, or Neurally adjusted Ventilatory assist) with a traditional mode (Pressure Support ventilation) on its the ability to detect patients ready for extubation (liberation from mechanical ventilation).
Detailed Description
Patients under mechanical ventilation who are suspected to be recovered and ready to return to spontaneous ventilation often undergo an spontaneous breathing trial (SBT) before extubation and liberation from mechanical ventilation. During the test, which lasts from 30 minutes to 2 hours , the patient receives minimal support from the ventilator, and the ICU team observes if the patient develops any signs or symptoms of discomfort or respiratory distress. If the patient tolerates the test, he or she is considered ready for extubation. The Neurally Adjusted Ventilatory Assist (NAVA) is a new mode of ventilation, shown to improve patient-ventilator synchrony. It has not been tested during SBTs. Our objective is to compare the performance of NAVA with the commonly used Pressure Support ventilation, during an SBT. Patients considered to be ready for an SBT by the ICU team will undergo two SBTs in random order: one in pressure support, and the other on NAVA, with a 1-hour interval between the tests. Ventilatory parameters and patient-ventilator interaction variables will be compared among the two tests. This study will help us understand if NAVA can be used during an SBT, which might be important for patients who are being ventilated with NAVA before the SBT is suggested, especially those how present a high asynchrony rate when ventilated with Pressure Support Mode.
Investigators
Eligibility Criteria
Inclusion Criteria
- •mechanical ventilation for more than 48 hours
- •Considered ready for an spontaneous breathing trial by the ICU team
- •informed consent for participation on the study signed by a family member
Exclusion Criteria
- •age \< 18yrs
- •pregnancy
- •facial trauma or burns that might interfere with the esophageal catheter placement
- •nasal pathologies that prevent adequate placement of the catheter
- •esophageal varices or gastroesophageal bleeding in the past 30 days
Outcomes
Primary Outcomes
rate of success on the spontaneous breathing trial
Time Frame: 30 minutes, or earlier (if the SBT is interrupted for intolerance), i.e., at the end of the spontaneous breathing trial
The ICU team will observe the patient during the spontaneous breathing trial, and use standard objective (blood gases) and subjective (including respiratory rate, tidal volume, comfort, hemodynamic variables) variables to determine if the patient tolerates the SBT and therefore is ready for discontinuation from mechanical ventilation
Secondary Outcomes
- Extubation failure rate(48 hours after extubation)