Advances in Ventilation — Neurally Adjusted Ventilatory Assist (NAVA)

Skorko, Agnieszka; Hadfield, Daniel; Shah, A.; Hopkins, Philip

doi:10.1177/175114371301400409

Cited by 3 publications

(2 citation statements)

References 49 publications

(87 reference statements)

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“…In addition to benefits in ventilation and clinical outcomes and despite no difference in sedation dose and RASS during in all MV modes, RASS scores were closer to zero in the NAVA mode compared to the PSV mode (p = 0.020), potentially indicating improved sedation management. Decreases in sedation may be driven by the need to optimise the Edi signal and ensure optimal levels of respiratory drive are present prior to the initiation of NAVA [28,29]. Improved synchrony and patient comfort when in the NAVA mode may further reduce sedative requirements.…”

Section: Discussionmentioning

confidence: 99%

Neurally adjusted ventilatory assist versus pressure support ventilation: a randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation

et al. 2020

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Background: The clinical effectiveness of neurally adjusted ventilatory assist (NAVA) has yet to be demonstrated, and preliminary studies are required. The study aim was to assess the feasibility of a randomized controlled trial (RCT) of NAVA versus pressure support ventilation (PSV) in critically ill adults at risk of prolonged mechanical ventilation (MV). Methods: An open-label, parallel, feasibility RCT (n = 78) in four ICUs of one university-affiliated hospital. The primary outcome was mode adherence (percentage of time adherent to assigned mode), and protocol compliance (binary-≥ 65% mode adherence). Secondary exploratory outcomes included ventilator-free days (VFDs), sedation, and mortality. Results: In the 72 participants who commenced weaning, median (95% CI) mode adherence was 83.1% (64.0-97.1%) and 100% (100-100%), and protocol compliance was 66.7% (50.3-80.0%) and 100% (89.0-100.0%) in the NAVA and PSV groups respectively. Secondary outcomes indicated more VFDs to D28 (median difference 3.0 days, 95% CI 0.0-11.0; p = 0.04) and fewer in-hospital deaths (relative risk 0.5, 95% CI 0.2-0.9; p = 0.032) for NAVA. Although overall sedation was similar, Richmond Agitation and Sedation Scale (RASS) scores were closer to zero in NAVA compared to PSV (p = 0.020). No significant differences were observed in duration of MV, ICU or hospital stay, or ICU, D28, and D90 mortality. Conclusions: This feasibility trial demonstrated good adherence to assigned ventilation mode and the ability to meet a priori protocol compliance criteria. Exploratory outcomes suggest some clinical benefit for NAVA compared to PSV. Clinical effectiveness trials of NAVA are potentially feasible and warranted.

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Section: Discussionmentioning

confidence: 99%

Neurally adjusted ventilatory assist versus pressure support ventilation: a randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation

et al. 2020

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“…Synchrony is improved by using a neural triggering mechanism (requires placement of a specialized nasogastric catheter positioned in the esophagus near the diaphragm). 39 The nasogastric catheter or EAdi catheter span the movement path of the patient’s diaphragm. The ventilator then receives signals from the EAdi catheter and modifies ventilator function to optimize ventilator synchrony with the patient’s neural and diaphragmatic electrical activity.…”

Section: Advanced Modes Of Invasive Mechanical Ventilationmentioning

confidence: 99%

Advanced Modes of Mechanical Ventilation: Introduction for the Critical Care Pharmacist

Cawley

2017

Journal of Pharmacy Practice

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Mechanical ventilation continues to be an evolving modality in the critical care environment. Technological advances in microprocessor-controlled ventilation integrated with the complexity of new ventilator modes has provided the multidisciplinary team opportunities to further improve the care of the critically ill ventilator patients. As members of the critical care multidisciplinary team, pharmacists require a basic understanding of both conventional and advanced modes of mechanical ventilation in order to assist in optimizing medication use and ultimately patient health-care outcomes. Pharmacists have a key responsibility to practice vigilance to maintain safe drug therapy use by preventing drug-drug or drug-disease interactions and optimal dose selection based upon pharmacokinetics and pharmacodynamics principles. Pharmacists also assist in the development of drug utilization guidelines and pharmacological ventilator-weaning protocols based upon evidence-based practice. The result of these responsibilities must include the continued longitudinal assessment and reporting of quality measures to assess ventilator weaning, time to liberation of mechanical ventilation, and length of care in intensive care unit. The purpose of this article is to provide the clinical pharmacist a guide to a basic understanding of advanced modes of mechanical ventilation in adults and to apply the knowledge gained to assist in the care of the critical care patients.

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The inscrutable signatures of patient-ventilator asynchrony: all the light we cannot see

Ventre

2021

Minerva Anestesiol

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Advances in Ventilation — Neurally Adjusted Ventilatory Assist (NAVA)

Cited by 3 publications

References 49 publications

Neurally adjusted ventilatory assist versus pressure support ventilation: a randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation

Neurally adjusted ventilatory assist versus pressure support ventilation: a randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation

Advanced Modes of Mechanical Ventilation: Introduction for the Critical Care Pharmacist

The inscrutable signatures of patient-ventilator asynchrony: all the light we cannot see

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