Neurally Adjusted Ventilatory Assist (NAVA) is a closed-loop mode of mechanical ventilation that provides ventilatory assistance in proportion to the electrical activity of the diaphragm (Edi). It is approved by the Food and Drug Administration for asynchrony in adults and children. We have successfully used NAVA for a variety of other indications and describe our clinical experience. METHODS: This retrospective study included mechanically ventilated adult patients age >18 years, who had NAVA mode documented from March 2014 to March 2019 in the intensive care unit at a tertiary care center. Data was extracted from electronic medical records, including demographics, past medical history, hospital stay, and ventilator data. For each patient, the ventilator data included indications for NAVA mode, other modes of mechanical ventilation used, and weaning days. RESULTS: NAVA mode was documented in 135 adult patients, with a median age of 64 (IQR 50-72) years and Charlson co-morbidity index of 4 (IQR 2-6). The most common primary diagnoses included pneumonia (23%), COPD exacerbation (17.6%), and trauma (13.2%). 40 (29.6%) patients died, 70 (51.8%) had a nonroutine discharge, and 21 (15.6%) were discharged home. The median hospital, ICU, and ventilator days were 33 (IQR 18-53.5), 26 (IQR 15-42), and 26 (IQR 11.5-42.5) days, respectively. 92 (68.1%) of the patients required or had previously undergone a tracheostomy. Indications for using NAVA were documented in 92 patients (68%). Of those, NAVA was used as a primary mode of ventilation in 61 subjects (66.3%) for failed ventilator weaning (33, 35.9%) or asynchrony (28, 30.4%), or as a diagnostic tool in 31 subjects (33.7%), namely assessment of neurologic or respiratory drive (24, 26.1%) or identification of auto-trigger (7, 7.6%). The median number of weaning days with an endotracheal tube and tracheostomy were 4 (IQR 1-7) and 2 (IQR 0-12), respectively. CONCLUSIONS: Mechanical ventilation with NAVA has not been widely adopted in the adult patient population and is indicated for monitoring a patient's breathing drive and improving synchrony. In this study, patients with autotriggering and prolonged ventilator weaning were also placed on NAVA. This study reports the clinical characteristics of patients placed on NAVA mode. Further exploration is warranted to determine optimal utilization with NAVA as a mode of ventilation.
