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Over-assistance during sleep is sensed on the previous three cycles preceding central apnea.
This was explained by the central apneas induced by over-assistance during PSV.
The microanalysis suggests an over-assistance with PSV during the N-REM stages, because 100% of the fragmentations in PSV occurred during this stage.
The tidal volume decrease in NAVA follows the respiratory physiologic changes during sleep, whereas in PSV we find a tidal volume oscillatory behavior due to constant inspiratory efforts, independent of the sleep stage and produces sequential over-assistance during N-REM sleep leading to a decrease in end-tidal CO2.
NAVA therefore decreases the risk of over-assistance.
In that study using the intratidal gas distribution technique, we demonstrated for the first time, less over-assistance during NAVA whereas there was marked over-assistance at higher pressure support levels [ 26].
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