Purpose: The purpose of this study was to compare the effect of varying levels of assist during pressure support (PSV) and Neurally Adjusted Ventilatory Assist (NAVA) on the aeration of the dependent and non-dependent lung regions by means of Electrical Impedance Tomography (EIT). Methods: We studied ten mechanically ventilated patients with Acute Lung Injury (ALI). Positive-End Expiratory Pressure (PEEP) and PSV levels were both 10 cm H2O during the initial PSV step. Thereafter, we changed the inspiratory pressure to 15 and 5 cm H2O during PSV. The electrical activity of the diaphragm (EAdi) during pressure support ten was used to define the initial NAVA gain (100 %). Thereafter, we changed NAVA gain to 150 and 50 %, respectively. After each step the assist level was switched back to PSV 10 cm H2O or NAVA 100 % to get a new baseline. The EIT registration was performed continuously. Results: Tidal impedance variation significantly decreased during descending PSV levels within patients, whereas not during NAVA. The dorsal-to-ventral impedance distribution, expressed according to the center of gravity index, was lower during PSV compared to NAVA. Ventilation contribution of the dependent lung region was equally in balance with the non-dependent lung region during PSV 5 cm H2O, NAVA 50 and 100 %. Conclusion: Neurally Adjusted Ventilatory Assist ventilation had a beneficial effect on the ventilation of the dependent lung region and showed less over-assistance compared to PSV in patients with ALI.

Acute lung injury, Electrical Impedance Tomography, Intratidal gas distribution, Mechanical ventilation, NAVA, Pressure support ventilation
dx.doi.org/10.1007/s00134-013-2898-8, hdl.handle.net/1765/65516
Intensive Care Medicine
Department of Intensive Care

Blankman, P, Hasan, D, van Mourik, M.S, & Gommers, D.A.M.P.J. (2013). Ventilation distribution measured with EIT at varying levels of pressure support and Neurally Adjusted Ventilatory Assist in patients with ALI. Intensive Care Medicine, 39(6), 1057–1062. doi:10.1007/s00134-013-2898-8