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Randomized Controlled Trial
. 2025 Feb 28;15(1):7158.
doi: 10.1038/s41598-025-91590-z.

Effect of neurally adjusted ventilator assist versus pressure support ventilation on asynchronies and cardiac function in pediatric liver transplantation

Fabrizio Chiusolo  1 , Giorgia Spinazzola  2 , Roberta Costa  3 , Alessio Franceschini  4 , Francesca Tortora  1 , Francesco Polisca  1 , Emanuele Rossetti  1 , Lucilla Ravà  5 , Marcello Chinali  4 , Vito Fanelli  6 , Giorgio Conti  3
Affiliations
Randomized Controlled Trial

Effect of neurally adjusted ventilator assist versus pressure support ventilation on asynchronies and cardiac function in pediatric liver transplantation

Fabrizio Chiusolo et al. Sci Rep. .

Abstract

In pediatric liver recipients perioperative factors may affect respiratory and cardiac function, and prolong mechanical ventilation during post-operative period. The use of NAVA can improve the interaction between the patient and the ventilator from both a respiratory and cardiac perspective. The objective of this study is to evaluate the synchronization between the patient and the ventilator, as well as cardiac function, during the application of neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in pediatric liver transplant recipients. This is a single-center, prospective, randomized, physiological cross-over controlled trial conducted between 2021 and 2022. Children (1 month-10 years old) who underwent liver transplantation were admitted to the pediatric intensive care unit. Patients were randomised to one of two crossover sequences of ventilation trials of 40 min each (PSV/NAVA/PSV or NAVA/PSV/NAVA). Cardiac function was studied by echocardiogram. Twenty-four patients were enrolled and 21 completed the study. Primary outcomes were variation of asynchrony index (AI) and tricuspid annular plane systolic excursion (TAPSE) during the two ventilation modes. Secondary outcomes were patient-ventilator interaction parameters, gas exchange, left and right ventricular function, and hemodynamic parameters. NAVA compared to PSV: (1) improves patient-ventilator interaction reducing AI (coeff - 6.66 95% CI -11.5 to -1.78, p = 0.008); (2) does not improve TAPSE (coeff 0.62 95% CI -1.49 to 2.74, p < 0.557) No differences in terms of pulmonary gas exchange and hemodynamic parameters were detected. NAVA (when compared to PSV) improves patient-ventilator interaction in terms of asynchronies without affecting cardiac biventricular function.Trial registration: NCT04792788, Registration date: 2021-03-11.

Keywords: Liver transplant; Neurally adjusted ventilatory assist; Patient ventilator asynchrony; Patient-ventilator interaction; Pediatric; Pediatric critical care; Ventricular function.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participants: NAVIGATE protocol was approved by institutional research board at Bambino Gesù Children’s Hospital (document 1695_OPBG_2018, March 19, 2019). All research was performed in accordance with relevant guidelines/regulations, and written informed consent was obtained from parents/legal guardian. The study has been performed in accordance with the Declaration of Helsinki.

Figures

Fig. 1
Fig. 1
Randomisation scheme and study phases. Eligible patients were randomised into Group 1 and Group 2 according to the study sequence.
Fig. 2
Fig. 2
Screening and randomization in a study of the effect of NAVA vs PSV in pediatric liver recipients.
See this image and copyright information in PMC

References

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