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SYSTEMATIC REVIEW OF THE USE OF NONINVASIVE NEURALLY ADJUSTED VENTILATORY ASSIST VS. CONVENTIONAL NONINVASIVE VENTILATION IN PEDIATRIC PATIENTS WITH ACUTE RESPIRATORY FAILURE
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  • João Souza,
  • Celso Rebello,
  • Carlos Oliveira,
  • Eduardo Troster
João Souza
Hospital Israelita Albert Einstein
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Celso Rebello
Hospital Israelita Albert Einstein
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Carlos Oliveira
Hospital Israelita Albert Einstein
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Eduardo Troster
Hospital Israelita Albert Einstein
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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.