PP165 Topic: AS15–Lung: Respiratory Support/Acute Respiratory Failure/Other: A PHYSIOLOGIC COMPARISON OF CONTINUOUS NEURALLY ADJUSTED VENTILATION (NEUROPAP) VS NEURALLY-ADJUSTED VENTILATORY ASSIST (NAVA) IN INFANTS WITH RESPIRATORY FAILURE
Bibliographic record
Abstract
Aims & Objectives: Tonic diaphragmatic activity is frequent during pediatric non-invasive ventilation (NIV) and suggests efforts to defend end-expiratory lung volumes. We assessed the impact of NeuroPAP, a new mode with continuous adjustment of pressure support proportionally to diaphragm electric activity (Edi) during both inspiration and expiration, in infants with respiratory failure Methods: This prospective non-randomized crossover study enrolled premature neonates (25-34 weeks) and infants with bronchiolitis supported by NIV-NAVA. Subjects were successively ventilated in NIV-NAVA (pre-study settings), in NeuroPAP, and again in NIV-NAVA. Delivered ventilatory pressures, Edi, cardio-respiratory events, neural breathing patterns, and systemic (estimated PF ratio–ePF) and cerebral (cNIRS) oxygenation were assessed. Results: Fifteen infants with bronchiolitis and 8 premature neonates were included. The group median PEEP was unchanged between modes, but breath-to-breath variability was significantly higher in NeuroPAP (p<0.001). In NeuroPAP, the individual median PEEP increased compared to pre-study settings in 7, decreased in 9, and was unchanged in 7 patients. The breathing pattern was phasic 74% and tonic 16% of time, compared to 61% (p=0.31) and 23% (p=0.36) in NAVA. The respiratory rate was lower in NeuroPAP; this was significant for the preterm group (p=0.006). The ePF ratio was higher in the second NIV-NAVA period after NeuroPAP phase; this was significant for the bronchiolitis group (p=0.006). There was no difference in Edi, heart rate, cNIRS, or in cardio-respiratory events. Conclusions: In infants with respiratory failure, NeuroPAP allowed dynamic control and personalization of end-expiratory pressures compared to NAVA and was well tolerated. Its impact on clinical outcomes warrants further evaluation. Keywords: PEEP, Infant, noninvasive ventilation
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".