Asynchrony index during noninvasive neurally adjusted ventilatory assist (NIV NAVA) in pediatrics: a systematic review

Abstract

Background: Noninvasive ventilation (NIV) is considered as the first preferred treatment of pediatric acute respiratory failure (ARF). Conventional NIV (CNIV) modes have a higher asynchrony index (AI) when compared to Noninvasive Neurally Adjusted Ventilatory Assist (NIV NAVA) mode. The present study aimed to compare the AI and clinical outcomes during NIV NAVA vs. CNIV in pediatric patients aged between one month and 18 y.

Methodology: This is a systematic review of clinical trials conducted between April and May 2020 in the electronic databases, Cochrane Library, Embase, Lilacs, Pubmed/Medline, Scopus and Web of Science.

Results: Four out of 184 studies were eligible for qualitative synthesis, presenting 50% “high risk” of bias in the randomization, allocation, and other bias. The sample analyzed 39 participants, aged between 35 days and 15 y, with male predominance (61.5%). The primary outcome analyzed in three out of four studies was the significant decrease (p < 0.001) in the AI during NIV NAVA. Clinical outcomes were inconclusive due to methodological limitations.

Conclusion: We conclude that NIV NAVA decreases the AI when compared to CNIV in pediatric patients with ARF. However, the association of the AI reduction and favorable clinical outcomes were inconclusive. Further studies with different methodological formats and larger sample sizes are required to offer definitive conclusions.

Registration: The study protocol was registered in PROSPERO: International Prospective Register of Systematic Reviews (ID: 181785).

Abbreviations: AI – Asynchrony index; ARF – Acute respiratory failure; AT – Automatic trigger; AVB – Acute viral bronchiolitis; DT – Double trigger; EAdi – Electrical activity of the diaphragm; ET – Expiratory time; IE – Ineffective effort; IT – Inspiratory time; LC – Latte cycling; MV – Mechanical ventilation; NCPAP – Nasal continuous positive airway pressure; NIPPV – Nasal intermittent positive pressure ventilation; NIV NAVA – Noninvasive neurally adjusted ventilatory assist; NIV – Noninvasive ventilation; CNIV – Conventional NIV; OI – Oxygenation index; PAC – Pressure assist control; PC – Premature cycling; PS – Pressure support; RoB – Risk of bias; SNIPPV – Synchronized nasal intermittent positive pressure ventilation; TcCO2 – Transcutaneous carbon dioxide; VILI – Ventilation induced lung injury

Keywords: Noninvasive Ventilation, Child, Support, Interactive Ventilatory, Neurally Adjusted Ventilatory Assist

Citation: de Souza JMF, Rebello CM, Oliveira CACD, Troster EJ. Asynchrony index during noninvasive neurally adjusted ventilatory assist (NIV NAVA) in pediatrics: a systematic review. Anaesth. pain intensive care 2021;25(5): 575-582; DOI: 10.35975/apic.v25i5.1622

Received: March 31, 2021, Reviewed: May 23, 2021, Accepted: May 24, 2021