The new neural pressure support (NPS) mode and the helmet: did we find the dynamic duo? in Journal of anesthesia, analgesia and critical care / J Anesth Analg Crit Care. 2024 Jun 10;4(1):35. doi: 10.1186/s44158-024-00170-6.

2024
AOU Alessandria
ASL Novara

Tipo pubblicazione

Journal Article

Autori/Collaboratori (7)Vedi tutti...

Cammarota G
Intensive Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milano, Milan, Italy.
Colombo D
Medical, Surgical and Transplant Physiopathology Department, Università Degli Studi Di Milano, Milan, Italy.
Grasselli G
Anesthesiology and Intensive Care, Università Degli Studi Di Padova, Padua, Italy.

et alii...

Abstract

BACKGROUND: Noninvasive ventilation (NIV) is commonly used in clinical practice to reduce intubation times and enhance patient comfort. However, patient-ventilator interaction (PVI) during NIV, particularly with helmet interfaces, can be challenging due to factors such as dead space and compliance. Neurally adjusted ventilatory assist (NAVA) has shown promise in improving PVI during helmet NIV, but limitations remain. A new mode, neural pressure support (NPS), aims to address these limitations by providing synchronized and steep pressurization. This study aims to assess whether NPS per se improves PVI during helmet NIV compared to standard pressure support ventilation (PSV). METHODS: The study included adult patients requiring NIV with a helmet. Patients were randomized into two arms: one starting with NPS and the other with PSV; the initial ventilatory parameters were always set as established by the clinician on duty. Physiological parameters and arterial blood gas analysis were collected during ventilation trials. Expert adjustments to initial ventilator settings were recorded to investigate the impact of the expertise of the clinician as confounding variable. Primary aim was the synchrony time (Time(sync)), i.e., the time during which both the ventilator and the patient (based on the neural signal) are on the inspiratory phase. As secondary aim neural-ventilatory time index (NVT(I)) was also calculated as Time(sync) divided to the total neural inspiratory time, i.e., the ratio of the neural inspiratory time occupied by Time(sync). RESULTS: Twenty-four patients were enrolled, with no study interruptions due to safety concerns. NPS demonstrated significantly longer Time(sync) (0.64?±?0.03 s vs. 0.37?±?0.03 s, p?