Comparing the impact of different modes of ventilation on cerebral blood flow in term infants with hypoxic-ischemic encephalopathy
Background. To date, there are no published results of large randomized controlled studies compared the differentiated influence of different modes of ventilation on cerebral perfusion in newborns with hypoxic-ischemic encephalopathy (HIE). New mode of ventilation named neurally adjusted ventilatory assist (NAVA) looks promising on this field, because it has already proved its advantages in premature babies. The purpose was to compare the impact of neurally adjusted ventilatory assist and other modes of ventilation on cerebral blood flow in the acute period of HIE in full-term neonates. Materials and methods. Data of 205 term infants with hypoxic-ischemic encephalopathy Sarnat stage II–III was collected during ≤ 72 hours of life. All the infants were randomized into the group of NAVA (n = 16) and the control group (n = 189), which included such modes of ventilation as pressure control (PC), synchronized intermittent-mandatory ventilation/pressure support ventilation (SIMV/PSV) and pressure-regulated volume control (PRVC). A multivariate dispersion analysis of the impact of NAVA and other modes of ventilation on cerebral perfusion during the acute period of neonatal hypoxic-ischemic encephalopathy was performed. Results. A significant difference was found between groups on day 3 of treatment at the end of the period of therapeutic hypothermia and the rewarming beginning in terms of Doppler resistive index (RI) of cerebral blood flow (0.70 [0.67–0.74] in the NAVA group and 0.66 [0.58–0.72] in the control group; p = 0.021) and the pulsatile index (PI) (1.3 [1.2–1.5] in the NAVA group and 1.2 [1.0–1.40] in the control group; p = 0.032). Also, analysis of variance results confirmed that compared with other ventilation modes, NAVA had a statistically significant positive influence both on the RI (p = 0.009) and on the PI (p = 0.012) at days 2 and 3 of observation. Conclusions. The neurally adjusted ventilatory assist demonstrated a positive impact on cerebral perfusion indices in full-term newborns during the acute HIE period compared with traditional modes of ventilation: PC, SIMV/PSV and PRVC.
Full Text:PDF (Українська)
Foster JP, Buckmaster A, Sinclair L, Lees S, Guaran R. Nasal continuous positive airway pressure (nCPAP) for term neonates with respiratory distress. Cochrane Database of Systematic Reviews. 2015;11:CD011962. doi: 10.1002/14651858.CD011962.
Dewez JE, van den Broek N. Continuous positive airway pressure (CPAP) to treat respiratory distress in newborns in low- and middle-income countries. Trop Doct. 2017;47(1):19-22. doi: 10.1177/0049475516630210.
Levene MI, de Vries L. Hypoxic-ischemic encephalopathy. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin's neonatal-perinatal medicine: diseases of the fetus and infant. 9th Ed. St. Louis, Missoury: Elseiver Mosby Inc; 2011. 952-975 pp.
Zanelli SA, Stanley DP. Hypoxic-ischemic encephalopathy. Available from: https://emedicine.medscape.com/article/973501-overview#a8. Available: Jul 18 2018.
Klingenberg C, Wheeler KI, McCallion N, Morley CJ, Davis PG. A comparison of volume-targeted ventilation modes with traditional pressure-limited ventilation modes for newborn babies. Cochrane Database Syst Rev. 2017;10:CD003666. doi: 10.1002/14651858.CD003666.pub4.
Wang C, Guo L, Chi C, et al. Mechanical ventilation modes for respiratory distress syndrome in infants: a systematic review and network meta-analysis. Crit Care. 2015;19:108. doi: 10.1186/s13054-015-0843-7.
Greenough A, Dimitriou G, Prendergast M, Milner AD. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000456. doi: 10.1002/14651858.CD000456.pub3.
Guthrie SO, Lynn C, Lafleur BJ, Donn SM, Walsh WF. A crossover analysis of mandatory minute ventilation compared to synchronized intermittent mandatory ventilation in neonates. J Perinatol. 2005;25(10):643-646. doi: 10.1038/sj.jp.7211371.
El-Rahman Ali AA, El-Razik El Wahsha RA, El-Sattar Aghaa MA, Tawadroosb BB. Pressure regulated volume controlled ventilation versus synchronized intermittent mandatory ventilation in COPD patients suffering from acute respiratory failure. Egyptian Journal of Chest Diseases and Tuberculosis. 2016;65(1):121-125. doi: 10.1016/j.ejcdt.2015.08.004.
Kallio M, Peltoniemi O, Anttila E, Pokka T, Kontiokari T. Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care--a randomized controlled trial. Pediatr Pulmonol. 2015;50(1):55-62. doi: 10.1002/ppul.22995.
Ducharme-Crevier L, Beck J, Essouri S, Jouvet P, Emeriaud G. Neurally adjusted ventilatory assist (NAVA) allows patient-ventilator synchrony during pediatric noninvasive ventilation: a crossover physiological study. Crit Care. 2015;19:44. doi: 10.1186/s13054-015-0770-7.
Liet J-M, Barrière F, Gaillard-Le Roux B, Bourgoin P, Legrand A, Joram N. Physiological effects of invasive ventilation with neurally adjusted ventilatory assist (NAVA) in a crossover study. BMC Pediatr. 2016;16:180. doi: 10.1186/s12887-016-0717-4.
Garcia-Muñoz Rodrigo F, Rivero Rodriguez S, Florido Rodriguez A, Martin Cruz FG, Diaz Pulido R. Successful weaning and extubation in the premature newborn using neuraly adjusted ventilatory assist. An Pediatr (Barc). 2015;82(1):e126-e130. doi: 10.1016/j.anpedi.2014.01.024. (in Spanish).
Piastra M, De Luca D, Costa R, et al. Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering fromsevere acute respiratory distress syndrome: Nested study. J Crit Care. 2014;29(2):312. e1-5. doi: 10.1016/j.jcrc.2013.08.006.
Gerner GJ, Burton VJ, Poretti A, et al. Transfontanellar duplex brain ultrasonography resistive indices as a prognostic tool in neonatal hypoxic-ischemic encephalopathy before and after treatment with therapeutic hypothermia. J Perinatol. 2016 Mar;36(3):202-6. doi: 10.1038/jp.2015.169.
Shetty S, Hunt K, Peacock J, Ali K, Greenough A. Crossover study of Assist Control ventilation and Neurally Adjusted Ventilatory Assist. Eur J Pediatr. 2017;176(4):509-513. doi: 10.1007/s00431-017-2866-3.
Copyright (c) 2020 CHILD`S HEALTH
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2020