Mechanical Ventilation With Neurally-Adjusted Ventilatory Assist in Patients With ARDS
Condition: Acute Respiratory Distress Syndrome
MeSH terms: Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Acute Lung Injury; Syndrome
Study type: Interventional

Summary: 
      Neurally-Adjusted Ventilatory Assist (NAVA) is a ventilatory mode that uses the electrical
      activity of the diaphragm to control the mechanical ventilator, offering inspiratory
      assistance in proportion to respiratory effort to patients who need artificial ventilatory
      support. It has been shown to improve the interaction between the patient and the mechanical
      ventilator in several clinical situations, but no previous studies have tried to use it for
      patients with a severe type of respiratory insufficiency, called Acute Respiratory Distress
      Syndrome (ARDS). Patients with ARDS benefit from a mechanical ventilatory strategy that
      includes low inspiratory volumes (tidal volumes) and limited airway pressures, but the
      application of such strategy frequently requires high levels of sedation. The investigators'
      hypothesis is that NAVA can be used for patients with ARDS, and that it will not be
      associated with excessive tidal volumes or elevated airway pressures.
    

Detailed description: 
      Neurally Adjusted ventilatory-Assist(NAVA) is an assisted ventilatory mode that captures the
      electrical activity of the diaphragm and uses it to initiate and terminate the inspiratory
      phase, offering inspiratory assistance in proportion to patient effort, cycle by cycle.
      Studies in animals and humans have shown that NAVA reduces the work of breathing and improves
      patient-ventilator interaction in comparison with traditional modes. Because it is an
      assisted mode, its use requires less sedation.

      The use of NAVA could contribute to the reduction of complications of prolonged mechanical
      ventilation in patients with Acute Respiratory Distress Syndrome (ARDS) submitted to
      protective ventilation with low tidal volumes and limited plateau pressure. However, there
      are no studies with NAVA in the acute phase of ARDS, in which assisted-controlled modes are
      generally used, allowing for adjustment of tidal volume and/or plateau pressure.

      With this project, the investigators intend to evaluate the behavior of NAVA mode in the
      acute phase of mechanical ventilation in ARDS patients, to assess whether this mode can be
      used to deliver an assisted lung protective ventilation strategy.
    

Intervention name(s): Pressure Support ventilation; NAVA
Intervention type(s): Other; Device
Intervention description(s): Patients will receive usual care during the period of ventilation on the Pressure Support. The same ventilator, the Servoi (maquet, Sweden) will be used.; Patients will be ventilated with NAVA for 15 minutes. Back up settings in pressure support mode will be set in case the esophageal catheter is misplaced, and back up settings in pressure control ventilation will be set in case no inspiratory efforts are detected for longer than 15 seconds
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: ARDS