SYSTEMATIC REVIEW OF THE USE OF NONINVASIVE NEURALLY ADJUSTED
VENTILATORY ASSIST VS. CONVENTIONAL NONINVASIVE VENTILATION IN PEDIATRIC
PATIENTS WITH ACUTE RESPIRATORY FAILURE
Abstract
The use of noninvasive ventilation (NIV) is considered for the treatment
of mild and moderate cases of acute respiratory failure (ARF).
Conventional trigger modes during NIV have a higher rate of asynchronies
when compared to the electrical activity of the diaphragm (AEdi)
trigger. Based on previous studies, the hypothesis of the present study
is that there is evidence of lower rate of asynchronies and favorable
clinical outcomes related to the non-invasive neurally adjusted
ventilatory assist (NIV NAVA) mode when compared to the use of
conventional NIV in pediatric patients with ARF. Purpose: To compare the
asynchrony index (AI) and clinical outcomes presented during the use of
NIV NAVA vs. conventional NIV in the treatment of ARF in pediatrics.
Methods: This is a systematic review of clinical trials conducted
between April and May 2020 in the electronic databases Cochrane Library,
Embase, Lilacs, Pubmed/Medline, Scopus and Web of Science. Results: A
total of 184 studies were found, four of which were eligible for
qualitative synthesis. The sample analyzed 39 participants, aged between
35 days and 15 years with male predominance (61.5%). The primary
outcome analyzed in three of the four studies was the significant
decrease (p <0.001) in the AI during NIV NAVA compared to
conventional NIV. Clinical outcomes were inconclusive due to
methodological limitations. Conclusion: We conclude that NIV NAVA
decreases the AI when compared to conventional NIV in pediatric patients
with ARF. However, the other clinical outcomes present inconclusive
results, requiring further studies with different methodological formats
for confirmation.