Respiratory Variability during NAVA Ventilation in Children: Authors’ Reply

[摘要] We thank Dr. Mhanna for his interesting comment (1) on our recent article about respiratory variability during different pediatric ventilatory conditions (2). In this article, we described different patterns of respiratory drive variability depending on the ventilatory modes, using synchrosqueezing transform (SST) to gage changes in the variability of the electrical diaphragm activity (EAdi). In particular, neurally adjusted ventilatory assist (NAVA) was associated with a respiratory pattern most resembling that of the pattern observed in a separate group of “normally breathing” children, without ventilatory support or respiratory distress. Dr. Mhanna appropriately underlines the difficulty to draw definitive conclusions based on our study design, in particular, because of the post hoc nature of the analysis and the slight differences between the mechanically ventilated group and the control group. Indeed, the patients in the control group were smaller [median 3.9 kg (interquartile 3.5–5.0) vs. 5.7 kg (4.8–6.7), p  = 0.04] and tended to be younger [1.5 months (1–3) vs. 4.5 (2.5–4.7), n.s.] (2). These limitations were acknowledged and discussed in our article, and we certainly agree to consider this work as a hypothesis-generating study rather than as a definitive study.

[学科分类] 儿科学

[关键词] pediatric intensive care;mechanical ventilation;neurally adjusted ventilatory assist;diaphragm;children