Application of neurally adjusted ventilatory assist in neonates.
Neurally adjusted ventilatory assist (NAVA) uses the electrical activity of the diaphragm (Edi) as a neural trigger to synchronize mechanical ventilatory breaths with the patient's neural respiratory drive. Using this signal enables the ventilator to proportionally support the patient's instantaneous drive on a breath-by-breath basis. Synchrony can be achieved even in the presence of significant air leaks, which make this an attractive choice for invasive and non-invasive ventilation of the neonate. This paper describes the Edi signal, neuroventilatory coupling, and patient-ventilator synchrony including the functional concept of NAVA. Safety features, NAVA terminology, and clinical application of NAVA to unload respiratory musculature are presented. The use of the Edi signal as a respiratory vital sign for conventional ventilation is discussed. The results of animal and adult studies are briefly summarized and detailed descriptions of all NAVA-related research in pediatric and neonatal patients are provided. Further studies are needed to determine whether NAVA will have significant impact on the overall outcomes of neonates.
Department of Neonatology, Toledo Children's Hospital, Toledo, OH 43606, USA. Electronic address: Howardstein@bex.net.
Howard
H
Stein
Department of Neonatology, Akron Children's Hospital, Akron, OH 44308, USA.
Kimberly
K
Firestone
D000818:Animals; D002986:Clinical Trials as Topic; D003964:Diaphragm / Q000502:physiology; D004576:Electromyography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059725:Interactive Ventilatory Support / Q000379:methods* / Q000592:standards; D009359:Neonatology / Q000379:methods* / Q000592:standards
Diaphragm; Electrical activity; Neural trigger; Neurally adjusted ventilatory assist; Neuroventilatory cascade; Patient–ventilator interaction; Synchrony