# Utilizing Spontaneous Ventilation Modes in Patients Underwent Corrective Surgery for Right Ventricular Outflow Tract Obstructive Congenital Heart Disease: A Crossover Study

## TL;DR

This study found that using spontaneous ventilation modes, especially NAVA, after heart surgery for congenital heart disease improves heart and lung function in patients.

## Contribution

The study demonstrates that spontaneous ventilation modes improve post-surgical hemodynamics in RVOTO-CHD patients.

## Key findings

- NAVA mode improved right ventricular cardiac index and contractility compared to PRVC and PSV.
- NAVA reduced lung water and improved respiratory mechanics like peak inspiratory pressure and compliance.
- All spontaneous modes showed better cardiac and respiratory outcomes than PRVC.

## Abstract

This study aimed to determine whether the hemodynamics of
patients with right ventricle outflow tract obstructive congenital heart disease
(RVOTO-CHD) improve after corrective surgery by changing the ventilation mode.

Patients with RVOTO-CHD who underwent corrective surgery were
enrolled in this study. Echocardiography and advanced hemodynamic monitoring were
performed using the pulse indicator continuous cardiac output (PiCCO) technology in the pressure-regulated volume control
(PRVC) mode, followed with switching to the pressure support ventilation (PSV)
mode and neurally adjusted ventilatory assist (NAVA) mode in random order.

Overall, 31 patients were enrolled in this study from April
2021 to October 2021. Notably, changing the ventilation mode from PRVC to a
spontaneous mode (PSV or NAVA) led to better cardiac function outcomes, including
right ventricular cardiac index (PRVC: 3.19 ± 1.07 L/min/m2
vs. PSV: 3.45 ± 1.32 L/min/m2
vs. NAVA: 3.82 ±
1.03 L/min/m2, p < 0.05) and right ventricle contractility
(tricuspid annular peak systolic velocity) (PRVC: 6.58 ± 1.40 cm/s
vs. PSV: 7.03 ± 1.33 cm/s vs. NAVA: 7.94 ± 1.50
cm/s, p < 0.05), as detected via echocardiography. Moreover, in the
NAVA mode, PiCCO-derived cardiac index (PRVC: 2.92 ± 0.54 L/min/m2
vs. PSV: 3.04 ± 0.56 L/min/m2
vs. NAVA: 3.20 ±
0.62 L/min/m2, p < 0.05), stroke volume index (PRVC: 20.38
± 3.97 mL/m2
vs. PSV: 21.23 ± 4.33 mL/m2
vs. NAVA: 22.00 ± 4.33 mL/m2, p < 0.05), and
global end diastolic index (PRVC: 295.74 ± 78.39 mL/m2
vs.
PSV: 307.26 ± 91.18 mL/m2
vs. NAVA: 323.74 ± 102.87
mL/m2, p < 0.05) improved, whereas extravascular lung water index
significantly reduced (PRVC: 16.42 ± 7.90 mL/kg vs. PSV: 15.42
± 5.50 mL/kg vs. NAVA: 14.4 ± 4.19 mL/kg, p <
0.05). Furthermore, peak inspiratory pressure, mean airway pressure, driving
pressure, and compliance of the respiratory system improved in the NAVA mode. No
deaths were reported in this study.

We found that utilizing
spontaneous ventilator modes, especially the NAVA mode, after corrective surgery
in patients with RVOTO-CHD may improve their right heart hemodynamics and
respiratory mechanics. However, further randomized controlled trials are required
to verify the advantages of spontaneous ventilation modes in such patients.

NCT04825054.