Application of neurally adjusted ventilatory assist for prolonged ventilator-dependent bronchopulmonary dysplasia patients

초록

Background and aims Bronchopulmonary dysplasia (BPD) often leads to a dependence on mechanical ventilation lasting many months. In these patients, cyanotic spells frequently occur and it causes long-term sedation therapy or intermittent muscle paralysis. Neurally adjusted ventilatory assist (NAVA) could provide precisely the amount of support that is needed by the patient without sedation. So we aimed to evaluate the impact of NAVA in ventilator-dependent severe BPD patient. Methods We reviewed medical records of preterm infants with severe BPD that required mechanical ventilator support more than 6 months during the period of 10 years. We compared two groups of patients; supported with NAVA and other ventilatory methods. We also evaluated the effect of NAVA after application in patients who supported with NAVA. Results There were 14 prematurely born patients required prolonged ventilatory support. Five patients were supported with NAVA and 9 patients were supported with other ventilatory modes except NAVA. Continuous sedative use duration was significantly shorter and sedative bolus use was also significantly lower in the NAVA applying group. In addition, patients supported with NAVA used lower dose of dexamethasone compared to patients with other modes of ventilation. In pre- and post-application comparison in patients with NAVA, cyanotic spells and sedatives use were significantly decreased after application of NAVA. Conclusions For severe BPD patients on prolonged ventilator care, NAVA could reduce cyanotic spells, which occurred during asynchrony between the patient and the ventilator. Also, NAVA could decrease the need of sedatives and dexamethasone use in this group of patients.