Neurally adjusted ventilatory assisted ventilation compared to pressure support during post-operative weaning of hepatic patients undergoing major abdominal surgeries: a randomized control trial

TL;DR

This study found that NAVA ventilation improves patient-ventilator synchronization and reduces mechanical ventilation time compared to PSV in post-operative hepatic patients.

Contribution

The study provides novel evidence that NAVA is superior to PSV in reducing asynchrony and improving outcomes in hepatic surgery patients.

Findings

NAVA had a significantly lower asynchrony index compared to PSV.

NAVA improved oxygenation and reduced the duration of mechanical ventilation.

Fewer NAVA patients required post-extubation CPAP and had lower sedation doses.

Abstract

Patient-ventilator asynchrony (PVA) is a discrepancy between the patient’s demands and the ventilator. Pressure support ventilation (PSV) is the most popular mode of partial ventilation. Neurally adjusted ventilatory assist (NAVA) tailors the level of assistance to the diaphragm’s electromyographic activity. We aimed to evaluate the PVA during NAVA versus PSV in hepatic patients undergoing Whipple operation.

This study was a prospective, randomized, controlled double-blind trial. 120 adult Child-Pugh A and B hepatic patients of both sexes aged 18 to 65 years, undergoing Whipple operation, completed the study. We excluded severely debilitated patients and contraindications to the placement of the NAVA probe. 60 patients in the PSV (group) received PSV weaning mode, and 60 in the NAVA (group) received NAVA weaning mode. Outcome measures were asynchrony index, duration of mechanical ventilation MV, application and duration of post-extubation non-invasive CPAP, total sedating drug doses used, and ICU stay.

The total asynchrony index was lower in the NAVA group than the PSV group, 6.12 ± 1.51 and 7.06 ± 1.25%, respectively, P < 0.001(95%CI 0.43 to 1.44). Cases with total ASI ≥ 10% were lower in the NAVA group than the PSV group, 6 and 16, respectively, P 0.02.The NAVA group had better oxygenation than PSV group, PaO2 and PaO2/FiO2 ratios were 208.53 ± 14.61 vs. 188.8 ± 25.55 mmHg, p < 0.001(95%CI -27.25 to -12.20) and 521.32 ± 36.52 vs. 472.01 ± 63.88, p < 0.001 (95%CI -68.12 to -30.50) respectively. The NAVA group had a lower duration of MV (4.05 ± 0.29 vs. 4.62 ± 0.52 h; P < 0.001(95%CI 0.41 to 0.72), auto-PEEP occurrence, and total doses of fentanyl and propofol than the PSV group.

NAVA serves better patient-ventilator interaction and synchronization than PSV, as indicated by a lower total asynchrony index, a reduced number of patients with total ASI ≥ 10%, the total doses of sedation used, the duration of MV needed, minimized need for post-extubation CPAP, and better oxygenation.

Menoufia University Faculty of Medicine research ethics committee IRB (N. and date 3/2020/ANET9), and National Liver Institute Menoufia University Institutional Review Board (NLI IRB 000140140). The study was retrospectively registered at the Pan African Clinical Trial with identification number PACTR202401894086611 on 26 January 2024.

The study was registered at the Pan African Clinical Trial with identification number PACTR202401894086611.

The online version contains supplementary material available at 10.1186/s12871-025-03159-y.

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