一项比较使用神经调节呼吸机辅助 (NAVA) 或适应性支持通气 (ASV) 对慢性阻塞性肺疾病急性加重患者进行无创通气的随机对照试验,Journal of Critical Care

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一项比较使用神经调节呼吸机辅助 (NAVA) 或适应性支持通气 (ASV) 对慢性阻塞性肺疾病急性加重患者进行无创通气的随机对照试验
Journal of Critical Care ( IF 3.2 ) Pub Date : 2023-01-19 , DOI: 10.1016/j.jcrc.2022.154250
Bharath A Chhabria ₁ , Kuruswamy Thurai Prasad ₁ , Sahajal Dhooria ₁ , Valliappan Muthu ₁ , Ashutosh Nath Aggarwal ₁ , Ritesh Agarwal ₁ , Raghava Rao Gandra ₁ , Inderpaul Singh Sehgal ₁

Affiliation

目的

没有研究比较神经调节呼吸机辅助 (NAVA) 与适应性支持通气 (ASV) 在慢性阻塞性肺疾病急性加重 (AECOPD) 受试者的无创通气 (NIV) 期间。

材料和方法

在这项随机对照试验中，我们比较了 NAVA-NIV 与 ASV-NIV 在连续 AECOPD 受试者中提供 NIV 的效果。主要结果是 NIV 失败率（有创机械通气）。关键的次要结果是 NIV 操作次数、异步指数和 90 天死亡率。

结果

我们招募了 76 名受试者（NAVA-NIV，n = 36，ASV-NIV，n = 40；74% 为男性），平均年龄为 61.4 ± 8.2 岁。我们发现两组之间的 NIV 失败率没有差异（NAVA-NIV 与 ASV-NIV；8/36 [22.2%] 与 8/40 [20%]；p = 0.83）。在最初的 24 小时内，ASV-NIV 组的 NIV 医生操作中位数明显少于 NAVA-NIV 组（2 [0.8–4] 对 3 [2–5]；p = 0.014）。我们发现中位异步指数（NAVA-NIV 与 ASV-NIV，16.6% 与 16.4%， p = 0.5）和 90 天死亡率（22.2% 与 17.5%，p = 0.67）没有差异。

结论

在降低 AECOPD 患者的 NIV 失败率方面，使用 NAVA-NIV 并不优于 ASV-NIV。NAVA-NIV 和 ASV-NIV 具有相似的异步指数和 90 天死亡率。

试用注册

www.clinicaltrials.gov (NCT04414891)。

"点击查看英文标题和摘要"

A randomized controlled trial comparing non-invasive ventilation delivered using neurally adjusted ventilator assist (NAVA) or adaptive support ventilation (ASV) in patients with acute exacerbation of chronic obstructive pulmonary disease

Purpose

No study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Materials and methods

In this randomized controlled trial, we compared NAVA-NIV with ASV-NIV for delivering NIV in consecutive subjects with AECOPD. The primary outcome was NIV failure rate (invasive mechanical ventilation). The key secondary outcomes were number of NIV manipulations, asynchrony index, and 90-day mortality.

Results

We enrolled 76 subjects (NAVA-NIV, n = 36, ASV-NIV, n = 40; 74% males) with a mean ± SD age of 61.4 ± 8.2 years. We found no difference in NIV failure rates between the two arms (NAVA-NIV vs. ASV-NIV; 8/36 [22.2%] vs. 8/40 [20%]; p = 0.83). The median physician manipulations for NIV were significantly less in the ASV-NIV arm than in the NAVA-NIV arm (2 [0.8–4] vs. 3 [2–5]; p= 0.014) during the initial 24-h. We found no difference in median asynchrony index (NAVA-NIV vs. ASV-NIV, 16.6% vs. 16.4%, p = 0.5) and 90-day mortality (22.2% vs. 17.5%, p = 0.67).

Conclusion

The use of NAVA-NIV was not superior to ASV-NIV in reducing NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV had similar asynchrony index and 90-day mortality.

Trial registry

www.clinicaltrials.gov (NCT04414891).

更新日期：2023-01-20

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