Neurally Adjusted Ventilatory Assist: Insufficient Evidence of Broad Clinical Outcomes

Sinderby, Christer A.

doi:10.4187/respcare.02643

Cited by 2 publications

(3 citation statements)

References 16 publications

(20 reference statements)

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“…Unlike the traditional pneumatic modes, neutrally adjusted ventilatory assist (NAVA) is a spontaneous mode, which triggers, cycles, and regulates gas delivery based on the diaphragmatic electromyography signal via a specially designed nasogastric tube (diaphragm electrical activity [Edi]). 14 – 16 The level of ventilatory assistance is proportional to the patient’s breathing effort, there is no influence of auto-PEEP during the ventilator cycle, since the assistance starts with the patient’s breathing effort, and there should not be any influence from leaks during NIV due to better patient-ventilator interaction. 14 , 17 …”

Section: Introductionmentioning

confidence: 99%

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A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation

Kuo¹,

Tu²,

Hung³

et al. 2016

COPD

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BackgroundPatient-ventilator asynchrony is a common problem in mechanically ventilated patients; the problem is especially obvious in COPD. Neutrally adjusted ventilatory assist (NAVA) can improve patient-ventilator asynchrony; however, the effect in COPD patients with prolonged mechanical ventilation is still unknown. The goals of this study are to evaluate the effect of NAVA and conventional weaning mode in patients with COPD during prolonged mechanical ventilation.MethodsThe study enrolled a total of 33 COPD patients with ventilator dependency for more than 21 days in the weaning center. A diaphragm electrical activity (Edi) catheter was inserted in patients within 24 hours after admission to the respiratory care center, and patients were randomly allocated to NAVA or conventional group. A spontaneous breathing trial was performed every 24 hours. The results correlated with the clinical parameters.ResultsThere were significantly higher asynchrony incidence rates in the whole group after using Edi catheter (before vs post-Edi catheter insertion =60.6% vs 87.9%, P<0.001). Asynchrony index: before vs post-Edi catheter insertion =7.4%±8.5% vs 13.2%±13.5%, P<0.01. Asynchrony incidence: NAVA vs conventional =0% vs 84.2%, P<0.001. Asynchrony index: NAVA vs conventional =0 vs 11.9±11.2 (breath %), P<0.001. The most common asynchrony events were ineffective trigger and delayed trigger.ConclusionCompared to conventional mode, NAVA mode can significantly enhance respiratory monitoring and improve patient-ventilator interaction in COPD patients with prolonged mechanical ventilation in respiratory care center.

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Section: Introductionmentioning

confidence: 99%

“…Moreover, NAVA can avoid the risk of excessive assistance and reduced ventilatory drive, and improve physiological parameters, with the delivery of lung protective tidal volumes while allowing patients to breathe spontaneously. 16 , 18 – 23 …”

Section: Introductionmentioning

confidence: 99%

A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation

Kuo¹,

Tu²,

Hung³

et al. 2016

COPD

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“…New ventilation modes such as NAVA [ 179 ], variable pressure support [ 151 ], automatic protective ventilation [ 173 ], proportional assist ventilation [ 180 ] and other non-conventional techniques [ 181 ] were developed as means to improve MV treatment. Unfortunately, the application of these MV modes remains limited due to a lack of clinical guidelines, based, in turn, on lack of methods to monitor and optimise their use for specific patients who might benefit.…”

Section: The Path Forward For Mechanical Ventilation and The Role Of mentioning

confidence: 99%

Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation

et al. 2018

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BackgroundMechanical ventilation is an essential therapy to support critically ill respiratory failure patients. Current standards of care consist of generalised approaches, such as the use of positive end expiratory pressure to inspired oxygen fraction (PEEP–FiO2) tables, which fail to account for the inter- and intra-patient variability between and within patients. The benefits of higher or lower tidal volume, PEEP, and other settings are highly debated and no consensus has been reached. Moreover, clinicians implicitly account for patient-specific factors such as disease condition and progression as they manually titrate ventilator settings. Hence, care is highly variable and potentially often non-optimal. These conditions create a situation that could benefit greatly from an engineered approach. The overall goal is a review of ventilation that is accessible to both clinicians and engineers, to bridge the divide between the two fields and enable collaboration to improve patient care and outcomes. This review does not take the form of a typical systematic review. Instead, it defines the standard terminology and introduces key clinical and biomedical measurements before introducing the key clinical studies and their influence in clinical practice which in turn flows into the needs and requirements around how biomedical engineering research can play a role in improving care. Given the significant clinical research to date and its impact on this complex area of care, this review thus provides a tutorial introduction around the review of the state of the art relevant to a biomedical engineering perspective.DiscussionThis review presents the significant clinical aspects and variables of ventilation management, the potential risks associated with suboptimal ventilation management, and a review of the major recent attempts to improve ventilation in the context of these variables. The unique aspect of this review is a focus on these key elements relevant to engineering new approaches. In particular, the need for ventilation strategies which consider, and directly account for, the significant differences in patient condition, disease etiology, and progression within patients is demonstrated with the subsequent requirement for optimal ventilation strategies to titrate for patient- and time-specific conditions.ConclusionEngineered, protective lung strategies that can directly account for and manage inter- and intra-patient variability thus offer great potential to improve both individual care, as well as cohort clinical outcomes.

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Neurally Adjusted Ventilatory Assist: Insufficient Evidence of Broad Clinical Outcomes

Cited by 2 publications

References 16 publications

A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation

A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation

Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation

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