2/2 The Diaphragmatic Initiated Ventilatory Assist (DIVA) Trial

总结 慢性肺部疾病和早产并发症是导致儿童寿命延长的主要原因 迷失在美国支气管肺发育不良（BPD）是一种慢性肺部疾病， 早产是儿童发病的主要呼吸道原因。仅在美国， 每年的医疗费用超过24亿美元。呼吸机诱导的肺损伤（VILI）是公认的 也是BPD的重要贡献者暴露于氧气和正压通气导致发育性 在未成熟早产儿肺中的停止和实质损伤。因此，肺保护策略优先考虑非 有创呼吸支持治疗早产儿呼吸衰竭，但无创失败率 呼吸支持（即：持续气道正压通气[CPAP]）高。在鼻用抗生素试验的荟萃分析中， 无创间歇正压通气（NIPPV），同步NIPPV显著降低了 与CPAP相比，BPD的发生率。非同步NIPPV未观察到这种益处。 然而，当前的标准同步方法是不可靠的，并且不能提供一致的 同步神经调节辅助通气（纳瓦）是一种新的方法，是FDA批准的技术 使无创支持（NIV）与婴儿呼吸驱动同步。这种有效的非侵入性 同步匹配电呼吸活动，以提供同步和准确的潮气量， 与神经信号成比例。在这些集群UG 3/UH 3和U24应用中，我们提出了一种实用的， 在妊娠240/7-276/7周的358例早产儿中进行的非盲、III期、随机对照试验（RCT） 呼吸衰竭判断是否NIV-NAVA，与非同步鼻间歇性阳性比较 压力通气（NIPPV），将减少拔管后5天内拔管失败的发生率， 机械通气

SUMMARY Chronic lung disease and complications from preterm birth are the leading pediatric contributors to years of life lost in the USA. Bronchopulmonary dysplasia (BPD), a chronic lung disease, is the most common sequela of prematurity and is the leading respiratory cause of childhood morbidity. In the United States alone BPD accounts for over $2.4 billion in healthcare costs annually. Ventilator induced lung injury (VILI) is an accepted and important contributor to BPD. Exposure to oxygen and positive pressure ventilation leads to developmental arrest and parenchymal injury in the immature preterm lung. Lung protective strategies therefore prioritize non- invasive respiratory support for preterm infants with respiratory failure, but failure rates of non-invasive respiratory support (ie: continuous positive airway pressure [CPAP]) are high. In meta-analysis of trials of nasal non-invasive intermittent positive pressure ventilation (NIPPV), synchronized NIPPV significantly reduced the incidence of BPD when compared with CPAP. This benefit was not seen with non-synchronized NIPPV. However, current standard means of synchronization are unreliable and do not deliver consistent synchronization. Neurally Adjusted Ventilatory Assist (NAVA), an FDA approved technology, is a novel method to synchronize non-invasive support (NIV) with infant respiratory drive. This effective non-invasive synchronization matches electrical diaphragmatic activity to deliver synchronized and accurate tidal volumes in proportion to the neural signal. In these clustered UG3/UH3 and U24 applications, we propose a pragmatic, unblinded, Phase III, randomized controlled trial (RCT) in 358 preterm infants 240/7-276/7 weeks gestation in respiratory failure to determine if NIV-NAVA, compared with non-synchronized nasal intermittent positive pressure ventilation (NIPPV), will reduce the incidence of extubation failure within 5 days of extubation from mechanical ventilation.