NAVA ventilation improves oxygenation index versus ACV in post-operative CDH infants
This dual-centre randomised crossover trial enrolled 11 infants with congenital diaphragmatic hernia (CDH) post-operatively, with 9 completing the trial. Infants were exposed to both neurally adjusted ventilatory assist (NAVA) and assist control ventilation (ACV) in a crossover design, with each mode assessed over a 4-hour period. The primary outcome was the oxygenation index (OI) after 4 hours.
After 4 hours, the mean OI was 3.9 ± 1.8 on NAVA compared to 5.9 ± 1.61 on ACV (p = 0.008). Secondary outcomes also favoured NAVA: peak Edi was 6.05 ± 4.5 µV versus 9.86 ± 7.3 µV (p = 0.028), peak inflation pressure was 17 ± 6.3 cmH2O versus 22 ± 5.3 cmH2O (p = 0.017), mean airway pressure was 8.7 ± 2.6 cmH2O versus 11.1 ± 1.8 cmH2O (p = 0.008), and expiratory tidal volume was 5.06 ± 0.71 ml/kg versus 9.86 ± 1.29 ml/kg (p = 0.043).
Safety and tolerability were not formally reported. Two infants were randomised but the trial was stopped for them due to a low Edi signal. The primary limitation is the very small sample size of 9 infants who completed the trial. The study was short-term and did not assess long-term clinical benefits, mortality, or major morbidity.
For practice, this provides preliminary physiological evidence that NAVA may improve short-term oxygenation and reduce ventilator pressures compared to ACV in post-operative CDH infants. The findings are hypothesis-generating and must be interpreted with caution due to the small size and short observation period. They do not support broad changes in ventilation strategy outside of this specific, monitored post-operative context.
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