Implementation of noninvasive neurally adjusted ventilatory assist in pediatric acute respiratory failure: a controlled before-after quality improvement study

Giovanna Chidini; Daniele De Luca; Edoardo Calderini; Stefano Scalia Catenacci; Tiziana Marchesi; Thomas Langer; Cesare Gregoretti; Giorgio Conti

doi:10.1186/s44158-021-00005-8

Implementation of noninvasive neurally adjusted ventilatory assist in pediatric acute respiratory failure: a controlled before-after quality improvement study

J Anesth Analg Crit Care. 2021 Sep 1;1(1):1. doi: 10.1186/s44158-021-00005-8.

Authors

Giovanna Chidini¹, Daniele De Luca², Edoardo Calderini³, Stefano Scalia Catenacci³, Tiziana Marchesi³, Thomas Langer⁴, Cesare Gregoretti⁵, Giorgio Conti⁶

Affiliations

¹ Pediatric Intensive Care Unit, Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. giovanna.chidini@policlinico.mi.it.
² Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, South Paris University Hospitals, APHP and South Paris-Saclay University, Paris, France.
³ Pediatric Intensive Care Unit, Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
⁴ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
⁵ Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.
⁶ Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy.

Abstract

Backgrounds: Pediatric noninvasive neurally adjusted ventilatory assist (NIV-NAVA) has been shown to improve patient-ventilator interaction but no data on clinical outcomes are available. Aim of this study was to compare NIV-NAVA with noninvasive pressure support (NIV-PS) in children with acute hypoxemic respiratory failure (AHRF), in a single-center before-after study. A cohort of thirty-four NIV-PS patients (before group) admitted to our PICU within the 2 years prior NAVA introduction was compared with a cohort of thirty children treated with NIV-NAVA during implementation phase (after group). The primary end-point was intubation rate between groups. Days on mechanical ventilation, number of invasive devices, nosocomial infections, PICU/hospital length of stay (LOS), and physiological parameters at 2 and 24 h after admission were considered.

Results: Intubation rate was lower in the NIV-NAVA group as compared to the NIV-PS group (p = 0.006). Patients treated with NIV-NAVA required fewer invasive devices (p = 0.032) and had lower incidence of ventilator-acquired pneumonia (p = 0.004) and shorter PICU (p = 0.032) and hospital LOS (p = 0.013). At 2 h, NIV-NAVA compared with NIV-PS resulted in higher paO₂:FIO₂ (p = 0.017), lower paCO₂ (p = 0.002), RR (p = 0.026), and HR (p = 0.009).

Conclusions: Early NIV-NAVA vs NIV-PS was associated to lower intubation rate and shorter PICU and hospital LOS. Further studies are needed in order to confirm these preliminary data.

Keywords: Acute respiratory failure; Children; Neurally adjusted ventilatory assist; Noninvasive ventilation.