Comparing noninvasive ventilation delivered using neurally-adjusted ventilatory assist or pressure support in acute respiratory failure

Abstract

BACKGROUND: The use of neurally-adjusted ventilatory assist (NAVA) during noninvasive ventilation (NIV) results in better patient-ventilator interaction. Whether this improves clinical outcomes lacks dedicated study. METHODS: In this randomized controlled trial, we compared NAVA with PSV for delivering NIV in consecutive subjects with de novo acute respiratory fail-ure. The primary outcomes were NIV failure rates and 28-d mortality. The secondary outcomes were asynchrony index, NIV-related complications, and others. RESULTS: We enrolled 100 subjects (50 subjects each for NAVA and PSV, 60% male) with a mean ± SD age of 56.7 ± 12 y. There was no difference in NIV failure rates (30% vs 32%, P = .83) and 28-d mortality rates (18% vs 34%, P = .07) between the NAVA and PSV arms, respectively. The median asyn-chrony index was significantly lower with NAVA (6.7 vs 44.8, P < .001). The use of NAVA significantly reduced NIV-related complications (32% vs 58%, P = .01). In a post hoc analysis, the use of NAVA significantly reduced the 28-d mortality in subjects with COPD exacerbation. CONCLUSIONS: The use of NAVA during NIV did not improve NIV failure rate or 28-d mortality in subjects with acute respiratory failure. However, patient-ventilator asynchrony and NIV-related complications were reduced with NAVA. Trial registry: www.clinicaltrials.gov (NCT03271671).