The Application Of NAVA In The Patients Of Severe Traumatic Wet Lung With ARDS

Severe traumatic wet lung (STWL) refers to lung injury, which was caused by various kinds of reasons resulting in a closed or open chest trauma, its clinical performance are the hypoxemia unable to be corrected by using drug and the increased respiratory failure, namely with acute respiratory distress syndrome (ARDS).Currently, ARDS is one of the most common lethal complications in intensive care unit (ICU), mechanical ventilation is still the most important means in the treatment of ARDS. In the clinical treating process of ARDS, there are many kinds of mechanical ventilation modes to choose. In recent years, along with the deepening understanding of the pathophysiology in ARDS, and the cognition of ventilator-induced lung injury (VILI), lung protective ventilation strategy was gradually raised. But how to choose the appropriate mode and parameters of ventilation are become the new proposition in front of us.Recently, the generally applicated conventional modes of mechanical ventilation are still inadequate in the respiratory mechanics and patient-ventilator synchrony, such as the increased airway pressure, the delayed trigger, the overloaded respiratory muscle, those above may cause respiratory fatigue, eventually lead to difficult weaning, prolong the duration of mechanical ventilation and hospitalization time. Along with the in-depth study of respiratory physiology, pathology and respiratory mechanics was integrated with modern science and technology, improved ventilation modes and new auxiliary devices continually come out. Neurally adjusted ventilatory assist (NAVA) as a new mode of mechanical ventilation, is to monitor the electrical activity of diaphragm (EAdi) signal as the foundation, directly triggered by patients nerve impulses, this mode can improve the patient-ventilator synchrony and respiratory mechanics effect, and put forward new research direction for making up the insufficient of traditional mechanical ventilation mode.Objective To compare the differences of patient-ventilator synchrony, respiratory mechanics, gas exchange capacity and hemodynamic in patients of severe traumatic wet lung (STWL), with use of neurally adjusted ventilatory assist (NAVA) or traditional press support ventilation (like PSV). Methods The study was based on18patients of STWL. They were ventilated with PSV or NAVA randomized at the beginning for120minutes, and then they were ventilated with the other mode. To compare the patient-ventilator synchrony, respiratory mechanics, gas exchange effects and hemodynamic, produced by the two ventilation modes. Results In the18cases, there were no significant differences in the homodynamic (HR, CVP) and gas exchange effects (pH, PaO2, PaCO2, SaO2) under the two ventilation modes (P>0.05). NAVA was superior to PSV in patient-ventilator synchrony (Trigger delay, Off cycle delay) and respiratory mechanics (PIP, Pmean), and the difference was significant (P<0.05). Conclusions Contrasted with PSV, NAVA had advantage in higher patient-ventilator synchrony and stability of respiratory mechanics in patients with STWL. However, NAVA and PSV had similar security in hemodynamic, oxygenation and gas exchange effects.