Neurally Adjusted Ventilatory Assist (NAVA)

Indications

  • xxx

Physiology

  • Neural Control of Mechanical Ventilation May Improve Coordination Between the Ventilator and Respiratory Muscle Activity, Enhancing Patient-Ventilator Synchrony
    • Patient Sets Their Own Respiratory Rate

Technique

  • Requires Esophageal Bipolar Electrode Catheter Placement to Detect Electrical Activity of the Crural Diaphragm: compared to skin electrodes, esophageal electrodes are not affected by activity of postural/expiratory muscles (assuming that there are no interfering esophageal lesions)
    • Sedation Should Be Minimized During NAVA
    • Neuromuscular Blockade Cannot Be Administered During NAVA
  • PEEP Affects the Position of the Diaphragm: for this reason, PEEP can be used as long as the esophageal electrodes are appropriately placed

Adverse Effects

Pulmonary Adverse Effects

  • xxxx

References

  • New modes of mechanical ventilation: Proportional assist ventilation, neurally adjusted ventilatory assist, and fractal ventilation.  Curr Opin Crit Care 2003; 9:51-58 [MEDLINE]
  • Titration and implementation of neurally adjusted ventilatory assist in critically ill patients.  Chest 2009; 135:695-703 [MEDLINE]
  • Influence of body position, PEEP and intra-abdominal pressure on the catheter positioning for neurally adjusted ventilatory assist.  Intensive Care Med 2011; 37:2041-2045 [MEDLINE]
  • Roles of neurally adjusted ventilatory assist in improving gas exchange in a severe acute respiratory distress syndrome patient after weaning from extracorporeal membrane oxygenation: a case report. J Intensive Care. 2016 Apr 7;4:26. doi: 10.1186/s40560-016-0153-4. eCollection 2016 [MEDLINE]