Neurally adjusted ventilatory assist after pediatric cardiac surgery: Clinical experience and impact on ventilation pressures

Abstract

BACKGROUND: After pediatric cardiac surgery, ventilation with high airway pressures can be detrimental to right ventricular function and pulmonary blood flow. Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interactions, helping maintain spontaneous ventilation. This study reports our experience with the use of NAVA in children after a cardiac surgery. We hypothesize that using NAVA in this population is feasible and allows for lower ventilation pressures. METHODS: We retrospectively studied all children ventilated with NAVA (invasively or noninvasively) after undergoing cardiac surgery between January 2013 and May 2015 in our pediatric intensive care unit. The number and duration of NAVA episodes were described. For the first period of invasive NAVA in each subject, detailed clinical and ventilator data in the 4 h before and after the start of NAVA were extracted. RESULTS: 33 postoperative courses were included in 28 subjects with a median age of 3 [interquartile range (IQR) 1–12] months. NAVA was used invasively in 27 courses for a total duration of 87 (IQR 15–334) h per course. Peak inspiratory pressures and mean airway pressures decreased significantly after the start of NAVA (mean differences of 5.8 cm H2O (95% CI 4.1–7.5) and 2.0 cm H2O (95% CI 1.2–2.8), respectively, P