The impact of neurally adjusted ventilatory assist mode on respiratory severity score and energy expenditure in infants: a randomized crossover trial

Objective:examine respiratory severity scores (rss) (mean airway pressure × fraction of inspired oxygen) and resting energy expenditure (ree) on neurally adjusted ventilatory assist (nava) compared with synchronized intermittent mandatory ventilation with pressure controlled and supported breath (simv (pc)ps).study design:a randomized, crossover trial in a level iv neonatal intensive care unit. twenty-four patients were ventilated with nava or simv (pc) ps for 12 h and then crossed over to the alternative mode for 12 h. the primary outcome (rss) and additional secondary respiratory outcomes were analyzed.results:rss and measured ree were not different between modes. on nava, peak inspiratory pressures were lower (17.8 vs 19.9 cmh2o (p<0.05)) without higher oxygen requirements. respiratory rates were higher on nava (52 vs 39 (p<0.05)), estimated work of breathing (wob) (0.01 vs 0.04 j l−1 (p<0.05)) was improved.conclusion:nava mode can be safe without increase in rss or ree. although respiratory rates were higher, this was offset by lower peak inspiratory pressures and wob during nava.