Neurally Adjusted Ventilatory Assist vs Proportional Assist Ventilation
Condition: Bronchopulmonary Dysplasia
MeSH terms: Bronchopulmonary Dysplasia
Study type: Interventional

Summary: 
      This study aims to assess whether neurally adjusted ventilatory assist or proportional assist
      ventilation is more effective in infants born prematurely with evolving or established
      bronchopulmonary dysplasia
    

Detailed description: 
      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. Synchronisation of mechanical
      breaths with the patient's respiratory effort offers the theoretical benefit of improving
      oxygenation and ventilation, requiring lower ventilator pressures, fewer air leaks and
      increased patient comfort.

      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 proportional assist ventilation (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. We have previously shown that PAV, compared to ACV,
      reduces the oxygenation index and improves respiratory muscle strength in infants born
      prematurely who remain ventilated at or beyond one week of life .

      Neurally adjusted ventilatory assist (NAVA) utilises the electrical activity of the diaphragm
      to trigger the ventilator. A modified nasogastric feeding tube with a series of electrodes
      allows monitoring of the diaphragmatic electromyogram (Edi). The waveform of the Edi is used
      to trigger and control ventilator support. We have recently shown that NAVA compared to ACV
      results in a lower oxygenation index in infants born prematurely who remain ventilated at or
      beyond one week of life.

      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 prematurely born neonates with evolving or established BPD.
    

Intervention name(s): NAVA; PAV
Intervention type(s): Device; Device
Intervention description(s): NAVA delivered by the Servo-n ventilator (Maquet); PAV delivered by the Stephanie ventilator (Stephan)
Other intervention name(s): neurally adjusted ventilatory assist; Proportional Assist Ventilation
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment