O-081Non-invasive Ventilation In Severe Viral Bronchiolitis With Failure Of Ncpap: Neurally Adjusted Ventilatory Assist Versus Pressure Assist/control Ventilation

BackgroundTo determine the prevalence of main inspiratory asynchrony events during non-invasive intermittent positive-pressure ventilation (NIV) for severe bronchiolitis in infants who failed to respond to nasal continuous positive airway pressure (nCPAP). Ventilator response time and asynchrony were compared in neurally adjusted ventilator assist (NAVA) and in pressure assist/control (PAC) modes.MethodsThis prospective study in a university hospital's paediatric intensive care unit included 11 children (aged 35.2 plus or minus 23 days) with respiratory syncytial virus bronchiolitis with failure of nCPAP. Patients received NIV for 2 h in PAC mode followed by 2 h in NAVA mode. Diaphragm electrical activity and pressure curves were recorded for 10 min. Trigger delay, main asynchronies (auto-triggering, double triggering, or non-triggered breaths) were analysed, and the asynchrony index was calculated.ResultsThe asynchrony index (fig. 1) was lower during NAVA than during PAC (3 plus or minus 3% vs. 38 plus or minus 21%, p < 0.0001), and the ventilator response time was shorter (43.9 plus or minus 7.2 vs. 116.0 plus or minus 38.9 ms, p < 0.0001). Ineffective efforts were significantly less frequent in NAVA mode (0.54 plus or minus 1.5 vs. 21.8 plus or minus 16.5 events/min, p = 0.01). Patient Respiratory rates were similar, but the ventilator rate was higher in NAVA than in PAC mode (59.5 plus or minus 17.9 vs. 49.8 plus or minus 8.5/min, p = 0.03). The TcPCO2 baselines values (8.6 plus or minus 1.6 kPa vs. 8.1 plus or minus 1.2 kPa during NAVA, p = 0.36) and their evolutions during the study period (-0.8 plus or minus 1.4 kPa vs. -1.6 plus or minus 2.3 kPa during NAVA, p = 0.36) did not differ.ConclusionSevere patient-ventilator inspiratory asynchronies and ventilator response times were much lower in NAVA mode than in PAC mode during NIV in infants with bronchiolitis.[Figure]