Feasibility of Non-invasive Neurally Adjusted Ventilator Assist After Congenital Diaphragmatic Hernia Repair
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In brief
In brief
First reported use of noninvasive neurally adjusted ventilator assist (NIV-NAVA) as a weaning strategy in seven CDH infants post-repair, including complex cases requiring patch repair and ECMO support. All patients survived to discharge and one-year follow-up, challenging traditional concerns about NAVA use in diaphragmatic pathology.
Written by the GCMD Library team from the article.
Background
The use of neurally adjusted ventilator assist (NAVA) in congenital diaphragmatic hernia (CDH) patients has been historically deemed unwise, since the trigger for breaths is the electromyographic activity of the diaphragmatic muscle. We report on our NAVA experience in CDH patients.
Methods
We performed an IRB-approved retrospective review of newborns from 1/1/2012–1/1/2017 at a Level I Children's Surgery Center undergoing CDH repair. Data obtained included demographics, defect type and repair, respiratory support, and outcomes.
Results
Seven infants with CDH were placed on noninvasive-NAVA (NIV-NAVA) after extubation. All seven patients underwent open transabdominal repair, with five requiring patch repair. All survived to discharge, and one year after birth. When we compared this group to a contemporary cohort of patients who also underwent CDH repair, we found no significant differences in birth weight, postmenstrual age, or gender. However, there was a significantly higher need for inhaled nitric oxide (p = 0.002), high frequency oscillatory ventilation (p = 0.016), and extracorporeal membranous oxygenation support (p = 0.045) in the NIV-NAVA cohort.
Conclusion
This is the first report of NIV-NAVA being successfully utilized as an adjunct to wean infants from conventional ventilation after CDH repair, even in those who require patch repair or with more significant disease severity.
Levels of Evidence
III- Retrospective Comparative Study.