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Intensive Care Medicine

, Volume 44, Issue 12, pp 2309–2311 | Cite as

Diaphragm myoclonus-induced autotriggering during neurally adjusted ventilatory assist

  • Luca Salvatore Menga
  • Giovanna Cammareri
  • Tamara Jovanovic
  • Antonio Maria Dell’Anna
  • Domenico Luca Grieco
  • Massimo Antonelli
Letter

Dear Editor,

Neurally adjusted ventilatory assist (NAVA) is activated by the electromyographic activity of the diaphragm (Edi) and delivers pressure-regulated respiratory support proportionally tailored to the patient’s neural effort. As compared to pressure support ventilation (PSV) and flow-based triggering systems, NAVA lowers trigger delay, limits the risk of over-assistance and improves patient–ventilator interaction [1, 2]. Little is known about how NAVA interacts with epileptic seizures.

An 85-year-old male patient with myasthenia gravis and chronic obstructive pulmonary disease was admitted to our intensive care unit due to viral meningoencephalitis with seizures and progressive neurological decay that led to intubation. Seizures were initially generalized and, after treatment (valproic acid 1.6 g/24 h and levetiracetam 3 g/24 h), became partial, mostly involving the right side of the body.

Early after intubation, the patient developed inhalation pneumonia, with lower left...

Notes

Compliance with ethical standards

Conflicts of interest

DLG has received payments for travel expenses by Maquet, Getinge and Air Liquide. MA has received payments for Board participation from Maquet, Air Liquide and Chiesi. All the other authors declare that no confict of interest exists regarding the material discussed in the manuscript.

References

  1. 1.
    Demoule A, Clavel M, Rolland-Debord C et al (2016) Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial. Intensive Care Med 42:1723–1732.  https://doi.org/10.1007/s00134-016-4447-8 CrossRefPubMedGoogle Scholar
  2. 2.
    Sehgal IS, Dhooria S, Aggarwal AN et al (2016) Asynchrony index in pressure support ventilation (PSV) versus neurally adjusted ventilator assist (NAVA) during non-invasive ventilation (NIV) for respiratory failure: systematic review and meta-analysis. Intensive Care Med 42:1813–1815.  https://doi.org/10.1007/s00134-016-4508-z CrossRefPubMedGoogle Scholar
  3. 3.
    Bellani G, Grasselli G, Teggia-Droghi M et al (2016) Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study. Crit Care 20:142.  https://doi.org/10.1186/s13054-016-1290-9 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Espay AJ, Fox SH, Marras C et al (2007) Isolated diaphragmatic tremor: is there a spectrum in “respiratory myoclonus”? Neurology 69:689–692.  https://doi.org/10.1212/01.wnl.0000267431.16316.69 CrossRefPubMedGoogle Scholar
  5. 5.
    Hahn A, Neubauer BA (2012) Epileptic diaphragm myoclonus. Epileptic Disord 14:418–421.  https://doi.org/10.1684/epd.2012.0540 CrossRefPubMedGoogle Scholar
  6. 6.
    Cvietusa PJ, Nimmagadda SR, Wood R, Liu AH (1995) Diaphragmatic flutter presenting as inspiratory stridor. Chest 107:872–875CrossRefPubMedGoogle Scholar
  7. 7.
    Allo JC, Beck JC, Brander L et al (2006) Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med 34:2997–3004.  https://doi.org/10.1097/01.ccm.0000242520.50665.9f CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Istituto di Anestesiologia e RianimazioneUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Scienze dell’emergenza, Anestesiologiche e della RianimazioneFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  3. 3.Department of Anesthesia and Intensive Care MedicineVittorio Emanuele University HospitalCataniaItaly

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