{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:55:50Z","timestamp":1787496950488,"version":"build-2736575974"},"reference-count":32,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Neurally Adjusted Ventilatory Assist (NAVA) is a patient-triggered ventilatory mode requiring intact respiratory drive. We compared 2 intravenous morphine infusion doses in infants with acute viral bronchiolitis receiving NAVA. The objectives were, to evaluate (1) impact on neural respiratory drive, measured by electrical activity of the diaphragm (EA\n                      <jats:sub>di<\/jats:sub>\n                      ) and estimated airway occlusion pressure (P\n                      <jats:sub>0.1<\/jats:sub>\n                      ) and (2) tolerability, via the COMFORT behavioral scale and physiological variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Randomized, nonblinded, crossover (morphine dose), feasibility trial. Infants likely requiring mechanical ventilation for &gt;48 h at enrollment received intravenous morphine infusion rates of 5 \u03bcg\/kg\/h (low dose) and 20 \u03bcg\/kg\/h (standard dose) on alternate days, via a randomized crossover design. On each day, a combination of 16 ventilatory settings were used, incorporating differing NAVA, PEEP and pressure support levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirteen participants received the intervention. The primary outcome, peak EA\n                      <jats:sub>di<\/jats:sub>\n                      did not differ between morphine groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .27), with an overall average of 12.2 \u00b1 7.0 \u03bcV. The mean P\n                      <jats:sub>0.1<\/jats:sub>\n                      was higher during low-dose morphine (1.14 vs 0.89 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O, mean difference .25 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O, 95% CI 0.12\u20130.39,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002). The low-dose group exhibited higher mean heart rates (123 vs 113 beats\/min, mean difference 9.9 beats\/min, 95% CI 5.2\u201314.6,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), systolic blood pressures (90 vs 86 mm Hg, mean difference 3.9\u2009mm\u2009Hg, 95% CI 0.4\u20137.5,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and COMFORT-B scores, (13.7 vs 13.2, mean difference 0.5, 95% CI 0.1\u20131.0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03). Low-dose morphine was associated with lower transcutaneous CO\n                      <jats:sub>2<\/jats:sub>\n                      levels (37 vs 43\u2009mm\u2009Hg, mean difference 6\u2009mm\u2009Hg, 95% CI 3.9\u20138.4\u2009mm\u2009Hg,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), despite no difference in between-group breathing frequency (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .11), tidal volume (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .16) or minute ventilation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .33).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Intravenous morphine at 20 \u03bcg\/kg\/h did\u00a0not blunt neural respiratory drive during NAVA and appeared\u00a0more favorable than 5 \u03bcg\/kg\/h in terms of tolerability. This may inform a larger trial evaluating NAVA in bronchiolitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654251377666","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T17:15:42Z","timestamp":1760462142000},"page":"139-148","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Morphine on Respiratory Drive in Infants With Acute Viral Bronchiolitis Receiving Neurally Adjusted Ventilatory Assist"],"prefix":"10.1177","volume":"71","author":[{"given":"Julia","family":"Harris","sequence":"first","affiliation":[{"name":"Drs. Harris, Crulli, Nyman, Freire-Gomez, Minen and Prof. Tibby are affiliated with Pediatric Intensive Care, Evelina London Children\u2019s Hospital, London, United Kingdom."},{"name":"Dr. Harris is affiliated with Department of Children\u2019s Nursing, London South Bank University, London, United Kingdom."},{"name":"Drs. Harris and Latour is affiliated with School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1057-1088","authenticated-orcid":false,"given":"Benjamin","family":"Crulli","sequence":"additional","affiliation":[{"name":"Drs. Harris, Crulli, Nyman, Freire-Gomez, Minen and Prof. Tibby are affiliated with Pediatric Intensive Care, Evelina London Children\u2019s Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos M.","family":"Latour","sequence":"additional","affiliation":[{"name":"Drs. Harris and Latour is affiliated with School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, United Kingdom."},{"name":"Dr. Latour is affiliated with Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China."},{"name":"Dr. Latour is affiliated with Curtin School of Nursing, Curtin University, Perth, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Nyman","sequence":"additional","affiliation":[{"name":"Drs. Harris, Crulli, Nyman, Freire-Gomez, Minen and Prof. Tibby are affiliated with Pediatric Intensive Care, Evelina London Children\u2019s Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xabier","family":"Freire-Gomez","sequence":"additional","affiliation":[{"name":"Drs. Harris, Crulli, Nyman, Freire-Gomez, Minen and Prof. Tibby are affiliated with Pediatric Intensive Care, Evelina London Children\u2019s Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Minen","sequence":"additional","affiliation":[{"name":"Drs. Harris, Crulli, Nyman, Freire-Gomez, Minen and Prof. Tibby are affiliated with Pediatric Intensive Care, Evelina London Children\u2019s Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7774-8656","authenticated-orcid":false,"given":"Shane M.","family":"Tibby","sequence":"additional","affiliation":[{"name":"Drs. Harris, Crulli, Nyman, Freire-Gomez, Minen and Prof. Tibby are affiliated with Pediatric Intensive Care, Evelina London Children\u2019s Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308723"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2021.07.009"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2021.5177"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4344-1"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2007.22.4.693"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200407-856OC"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-007-0882-x"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-010-2052-9"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4447-8"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002727"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-03957-7"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001485"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-011-2352-8"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.23084"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2061"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"},{"key":"e_1_3_4_18_2","unstructured":"Maquet. (2008) NAVA study guide. V1.6. Maquet: Sweden. Available at https:\/\/www.phillipelefevre.com\/downloads\/guidelines\/equipment\/NAVA.pdf"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000680"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000446-200501000-00019"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0304-3959(99)00239-0"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-1747"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003407"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc110"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005113"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.3233\/THC-230096"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-012-2535-y"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2013.08.006"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-5153.2012.00541.x"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13070"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2012.64"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1203\/PDR.0b013e31819e72ab"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181cb0d7b"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654251377666","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19433654251377666","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654251377666","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:35:08Z","timestamp":1787135708000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19433654251377666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1177\/19433654251377666"],"URL":"https:\/\/doi.org\/10.1177\/19433654251377666","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]}}}