ESICM 2011 programme is available in notes
http://www.springerlink.com/content/m0xth64u3885w270/</a

Bialais, E.

Chase, J.G.

Chiew, Y.S.

Desaive, T.

Jolliet, P.

Lambermont, B.

Piquilloud, L.

Revelly, J.P.

Roeseler, J.

Tassaux, D.

UC Research Repository

YS Chiew 1), L. Piquilloud 2), , T. Desaive 3), B. Lambermont 4), J. Roeseler 5), JP Revelly2), E. Bialais 5), D. Tassaux 6), P. Jolliet 2), J.G. Chase 1)    1) Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand  2) Intensive Care and Burn Unit, University Hospital, Lausanne, Switzerland  3) Cardiovascular Research Center, University of Liege, Liege, Belgium  4) Intensive Care Unit, CHU Sart-Tilman, Liege, Belgique  5) Intensive Care Unit, Cliniques Universitaires St-Luc, Brussels, Belgium   6) Intensive Care Unit, University Hospital, Geneva, Switzerland   Effect of various Neurally Adjusted Ventilatory Assist (NAVA) gains on the relationship between diaphragmatic activity (Eadi max) and tidal volume (Vt)  NAVA Introduction (1) NAVA  Eadi based triggering  Eadi based cycling Proportional assist ventilation  Paw = NAVA gain x Eadi   Neurally adjusted ventilatory assist (NAVA) is an assisted ventilatory mode in which the electrical activity of the diaphragm (Eadi) is used to pilot the ventilator. Eadi Paw Flow Introduction (2)  NAVA improves patient-ventilator synchrony(1)        (1) Piquilloud et al. Intensive Care Med;2011 ; 37 :263-71      Little is  known about how to set the NAVA gain i.e.,      how to choose the ratio between Eadi and delivered     pressure.       NAVA NAVA    To assess the relationship between Eadi max and     tidal volume (Vt) at various NAVA gain settings     To evaluate whether modifying the gain influenced       the Vt/Eadi max relationship in non-invasively       ventilated (NIV) patients. Study objectives Tin NAVA Methods (1)  Prospective interventional study    Comparison of 3 NAVA gain values during NIV (20     minutes each).  - NAVA100: gain set by the clinician according to             the manufacturer’s recommendations (same P             max as in pressure support)   - NAVA50: gain set as -50% of NAVA100 gain  - NAVA150: gain set as +50% of NAVA100 gain    Recording of Eadi max and tidal volume (Vt) for each      respiratory cycle  Assessment of Vt/Eadi max ratio for each breath and     each NAVA gain   Determination of Range 90 (Range 5-95) for each      patient and each NAVA gain setting Vt [ml]  Eadi max[µV] Eadi max [µV] Eadi max [µV] 20 20 60   20 60   60         p95 p50 p5 p95 p5 p50 A smaller Range90 indicates a better matching of Vt to Eadi max. Methods (2) NAVA   12 patients included   5 COPD  2 mixed pulmonary disease   Median [IQR] Range 90 for each gain setting: NAVA 50 NAVA 100 NAVA 150 Range 90 37 [20-95] 32 [19-87] 33 [16-92]      Globally NAVA100 allowed the best matching     between Eadi max and Vt Results (1) NAVA   If Range 90 was considered for each NAVA gain       setting patient by patient:   Lowest Range90 value was:   - under NAVA 100 in 4 / 12 patients (33%)  - under NAVA 150 in 2 /12 patients (17%)  - under NAVA 50 in 6/12 patients (50%) NAVA100 was not the best NAVA gain for minimizing Range 90 in every patients.   Results (2) NAVA  If the lowest Range90 value was compared to the    next lowest for each patient   - 3 patients had differences of less than 10%    - 9 patients had differences from 17-24%                     most patients (9/12 or 75%) had a clear better           match between Eadi max and Vt for one           specific NAVA gain.    Results (3) NAVA   Range 90 assesses the matching      between Eadi max and  Vt    Different NAVA gains yield      a different ability to match Vt       to Eadi max.    Range 90 approach could be a      new way to determine  the optimal      NAVA gain for a given patient at a      given time but requires further       investigations. Conclusions 

Effect of various Neurally adjusted ventilatory assist (NAVA) gains on the relationship between diaphragmatic activity (Eadi max) and tidal volume (Vt)

http://ir.canterbury.ac.nz/bitstream/handle/10092/6373/12635898_ESICM%20Berlin_E_poster_2011.piquilloud_def.pdf?sequence=1&isAllowed=y

Effect of various Neurally adjusted ventilatory assist (NAVA) gains on the relationship between diaphragmatic activity (Eadi max) and tidal volume (Vt)

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