Neurally adjusted ventilatory assist versus conventional ventilation in the pediatric population: Are there benefits?

Abstract

Introduction Neurally‐adjusted ventilator assist (NAVA) is a relatively new form of ventilation in which the electrical activity of the diaphragm is sensed by a catheter. The amplitude of this electrical signal is then used to deliver an appropriately proportioned pressure supported breath to the patient. Due to the synchronous nature of the breaths and the patient‐adjusted nature of the support, NAVA has been shown to have benefits over conventional ventilation. Meta‐analyses were conducted of published pediatric studies to compare ventilatory endpoints between NAVA and conventional ventilation. Methods Studies comparing ventilatory parameters between NAVA and conventional ventilation in pediatric patients were identified. These studies were reviewed for appropriateness for inclusion and studies of only pediatric patients with data for similar endpoints between both arms were then pooled. Results Statistically significant differences were noted in asynchrony, peak inspiratory pressure (PIP), and oxygen saturation by pulse oximetry. Asynchrony was 17% lower with NAVA, PIP was 1.74 cmH20 lower with NAVA, and oxygen saturation was 1.1% greater with NAVA. There was no statistically significant difference in peak expiratory pressure, mean airway pressure, electrical diaphragmatic activity, respiratory rate, hydrogen ion concentration, partial pressure of oxygen, or partial pressure of carbon dioxide. Conclusion Statistically significant differences were noted in percent asynchrony, PIP, and oxygen saturation when comparing NAVA to conventional ventilation. These all tended to favor NAVA. Other than percent asynchrony, however, the other statistically significant findings were not clinically significant.

Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study

“…Our results confirm that NAVA significantly reduces patient-ventilator asynchrony and significantly increases oxygenation compared to conventional assisted mechanical ventilation [37]. In fact, in our study, the better synchrony with NAVA was confirmed by a significantly longer Time sync and substantially better Time sync /Ti neu.…”

“…Other studies [14,37] highlighted the positive effect of NAVA on PaO 2 /FiO 2 ratio, but they did not show significant effects on PaCO 2 as reported in our study, probably due to the recovery of a normalized respiratory pattern with normocapnia in patients recovering from PARDS.…”

“…The pea-kEdi during PSV trials showed reduced values, as possible expression of over assistance in PSV mode. This ability of NAVA to maintain the characteristic variability of spontaneous breathing has been demonstrated in several studies [13,37], that highlighted the significant effect of NAVA on tidal volume and airway pressure variability with respect to conventional ventilation. In our study, despite the observed improvement in patientventilator interaction with NAVA, this difference in tidal volume was not observed probably because the PSV setting used during our study, set to avoid a long Timech, allowed to deliver similar Vtmech and Vtneu in all conditions.…”

“…The effect of NAVA on PeakEdi is particularly interesting: in a recent review, Karikari and colleagues [37] described how NAVA may affect the electrical activity of the diaphragm, although not significantly, maintaining the large variability of Edi, a characteristic observed in spontaneous breathing. In our study, we observed a trend toward a rise of peakEdi during NAVA.…”

2019 Year in Review: Patient-Ventilator Synchrony

“…Karikari et al 47 performed a meta-analysis of published pediatric studies to compare ventilatory end points between NAVA and conventional ventilation. Asynchrony was 17% lower, peak inspiratory pressure was 2 cm H 2 O lower, and S pO 2 was 1% greater with NAVA.…”