Diaphragm myoclonus-induced autotriggering during neurally adjusted ventilatory assist
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...
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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.
- 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
- 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
- 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