Recording of a left ventricle assist device electrical current with a neurally adjusted ventilation assist (NAVA) catheter: a small case series.

Autor: Mohamed MSA; Department of Anaesthesiology, University Medical Center of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany., Moerer O; Department of Anaesthesiology, University Medical Center of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany., Harnisch LO; Department of Anaesthesiology, University Medical Center of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany. lars-olav.harnisch@med.uni-goettingen.de.
Jazyk: angličtina
Zdroj: Journal of clinical monitoring and computing [J Clin Monit Comput] 2023 Dec; Vol. 37 (6), pp. 1635-1639. Date of Electronic Publication: 2023 Jul 17.
DOI: 10.1007/s10877-023-01055-9
Abstrakt: Background: Neurally Adjusted Ventilatory Assist (NAVA) is an adaptive ventilation mode that recognizes electromyographic diaphragmatic activation as a sensory input to control the ventilator. NAVA may be of interest in prolonged mechanical ventilation and weaning, as it provides effort-adapted support, improves patient-ventilator synchronization, and allows additional monitoring of neuromuscular function and drive. Ventricular assist devices (VAD), especially for the left ventricle (LVAD), are increasingly entering clinical practice, and intensivists are faced with distinct challenges such as the interaction between the system and other measures of organ support.
Case Presentation: We present two cases in which a NAVA mode was intended to support ventilator weaning in patients with recent LVAD implantation (HeartMate III ® ). However, in these patients, the electrical activity of the diaphragm (Edi) could not be used to control the ventilator, because the LVAD current detected by the catheter superposed the Edi current, making usage of this mode impossible.
Discussion/conclusions: An implanted LVAD can render the NAVA signal unusable for ventilatory support because the LVAD signal can interfere with the recording of electromyographic activation of the diaphragm. Therefore, patients with implanted LVAD may need other modes of ventilation than NAVA for advanced weaning strategies.
(© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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