The significant tongue weakness observed in 16 weak patients with Guillain-Barr�� syndrome correlated with the alterations in respiratory etc parameters [86]. Additional physiological studies are required to document the potential benefits of NAVA on swallowing-breathing interactions during NIV.Sleep quality during NIV has been shown to be a predictor of success or failure [87]. Sleep quality can also be improved compared with standard NIV settings by careful physiological titration of the ventilator settings [88]. Patient-ventilator asynchrony can cause sleep disruption. Bosma and colleagues demonstrated that PAV, a mode of partial ventilatory support in which the ventilator applies pressure in proportion to the inspiratory load, was more effective than PSV in matching the ventilatory requirements to the level of ventilator assistance, thereby resulting in fewer patient-ventilator asynchronies and better quality of sleep [11].

Delisle and colleagues recently obtained sleep recordings during a crossover study comparing NAVA and PSV in 14 mechanically ventilated patients [89]. Each condition was studied for 4 hours, and recordings were obtained over 19 consecutive hours in all. Patient-ventilator asynchrony varied significantly across sleep stages, and no asynchrony occurred with NAVA. Overassistance occurred only with PSV, which probably explained the improvements in physiological indices of sleep quality observed with NAVA.Neurally adjusted ventilatory assist in children and infantsMV in children and in low-birth-weight infants is more difficult to apply than in adults and has several speciicities.

First infants take a very small tidal volume, have a rapid respiratory rate, have a limited chest wall musculature, and have variable and fluctuating lung compliance. Second, most neonatal units use uncuffed tracheal tubes for fears of pressure necrosis and air leak is always present, making reliable measurements and triggering problematic. Third, ventilators that are efficient in adults are not systematically efficient in children and infants, mainly because the inspiratory triggers are not sufficiently sensitive for early detection of infants’/children’s inspiratory effort [90].Whether or not the respiratory drive of the preterm infant is suitable to control MV is unknown. Beck and colleagues first evaluated patient-ventilator interaction with NAVA in seven very-low-birth-weight infants [29].

As suggested by previous animal studies [91], they demonstrated that Anacetrapib NAVA could be implemented for a short-term period, both invasively and noninvasively, in infants with body weight as low as 640 g up to 3 years old. During invasive ventilation with NAVA, EAdi and ventilator pressure were correlated and patient-ventilator synchrony was improved compared with the other mode.