Comparaison de la dépense énergétique des patients de réanimation ventilés en mode NAVA et VSAI

Abstract : Introduction: Mechanical ventilation is the organ supply the most frequently used in Critical Care. Mortality is known to be correlated with the duration of mechanical ventilation. The latter must therefore be kept to the minimum. In order to achieve this, various settings must be optimized to facilitate the respiratory weaning. Among these, using a proportional mode of mechanical ventilation, the NAVA, and improving the nutritional status by the evaluation of the energy expenditure seem particularly interesting. These two aspects, breathing and nutrition are indeed closely related. Material and Methods: A controlled, prospective, monocentric, randomized, crossover study was conducted. Its main goal is to know whether the NAVA could reduce the patient’s energy expenditure compared to the PSV. The main outcome is the total energy expenditure, evaluated by indirect calorimetry. As secondary outcomes ventilator synchrony and haematosis of the patients are evaluated. Results: Compared with the PSV, NAVA reduces the energy expenditure from 36.3 [30.9 to 40.3] Kcal / kg / day to 27.3 [22.9 to 30.4] Kcal/kg/day with p <0.0001. It also improves patient-ventilator synchrony and haematosis. Discussion: Assuming that patients are identical during the two periods, a decreased work of breathing in NAVA compared to PSV could explain this result. The latter may come from the reduction of asynchrony, which represents a large waste of energy, or from the beneficial effects on the auto-PEEP.
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Master Thesis
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Submitted on : Monday, January 23, 2017 - 8:55:45 AM
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Henri-Louis Dupré. Comparaison de la dépense énergétique des patients de réanimation ventilés en mode NAVA et VSAI. Médecine humaine et pathologie. 2015. ⟨dumas-01421413⟩

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