461 - Factors associated with successful extubation from invasive neurally adjusted ventilatory assist (NAVA) among very preterm infants with severe lung disease.

Poster Number: 461
Publication Number: 461.229

Kathleen E. Hannan, University of Colorado School of Medicine, DENVER, CO, United States; Stephanie L. Bourque, University of Colorado School of Medicine, Greenwood Village, CO, United States; Claire Palmer, University of Colorado School of Medicine, Aurora, CO, United States; Satya Houin, University of Colorado School of Medicine, Denver, CO, United States; Jason Gien, University of Colorado School of Medicine, Englewood, CO, United States; John P. Kinsella, University of Colorado School of Medicine, Highlands Ranch, CO, United States; Stephanie S. Chassen, University of Colorado Neonatology, Aurora, CO, United States; Brian K. Walsh, Children's Hospital Colorado, Aurora, CO, United States; Pavika Varma, Children's Hospital Colorado, Denver, CO, United States; Erica M. Wymore, University of Colorado School of Medicine, Aurora, CO, United States; Laura Sherlock, UC Denver, Denver, CO, United States; Danielle Smith, Children's Hospital Los Angeles, Aurora, CO, United States; Erica Mandell, University of Colorado School of Medicine, Aurora, CO, United States

Background: Use of neurally adjusted ventilatory assist (NAVA) ventilation has increased among preterm infants requiring invasive and/or noninvasive respiratory support. The utility of weaning invasive NAVA ventilation to facilitate extubation among very preterm (VPT) infants with severe evolving or established bronchopulmonary dysplasia has not been studied.

Objective: 1) Assess the characteristics of VPT infants who received respiratory support using NAVA ventilation. 2) Evaluate the association between clinical factors and successful extubation among VPT infants on invasive NAVA.

Design/Methods: We retrospectively reviewed all VPT infants ( < 32 weeks gestation) who received NAVA ventilation between January 2016 and September 2021 in a level 4 NICU. We excluded infants on NAVA for < 24 hours or who received NAVA outside the NICU. Demographic and clinical variables were compared using two-sample t-tests and Fisher's exact tests. Wilcoxon rank-sum tests were used for non-normally distributed continuous variables. Successful extubation was defined as remaining extubated for >14 days, and survival to discharge without a tracheostomy.

Results: Fifty-nine VPT infants received NAVA. Of those, 35 infants received invasive NAVA and 24 infants received non-invasive (NI) NAVA support. The mean gestational age was 26+3 weeks and birthweight 790g (IQR 670-1010g). Among infants on invasive NAVA, the median length of stay was 201 days (IQR 146,292), NAVA was initiated on day of life 97, and the mean respiratory severity score (RSS) was 6+/-3(Table 1). Among these VPT infants, 44% received a tracheostomy and 11% died prior to discharge. Infants who successfully extubated from invasive NAVA had similar Respiratory Severity Scores (RSS), PEEP, and FiO2 prior to NAVA initiation compared to those not successfully extubated (Table 2). Those who were successful had a lower initial NAVA level (1.5 vs. 2.1, p < 0.01). Among those successfully extubated, the average NAVA level at extubation was 1, and most (76%) were extubated to non-invasive NAVA (Table 3).Conclusion(s): VPT infants successfully extubated from invasive NAVA after prolonged mechanical ventilation requirements had lower NAVA levels at time of NAVA initiation. Among VPT with prolonged invasive mechanical ventilation or non-invasive positive pressure requirements, the use of NAVA, particularly later in the respiratory course, is an emerging therapeutic option to facilitate extubation. Further work is needed to determine efficacy of NAVA compared to traditional modes of ventilation at promoting extubation among this population.
Table 1. Characteristics of infants who received NAVA invasively.*Continuous variables presented as mean + SD or median (IQR). +Length of stay at level IV NICU only. #Respiratory severity score (RSS) calculated by multiplying mean airway pressure and FiO2.
Table 2. Clinical characteristics of invasive NAVA runs that resulted in successful extubation versus those that did not.