Neurally Adjusted Ventilatory Assist (NAVA)

Excerpt

Although the earliest reported use of mechanical ventilation was in the 16th century, it was not employed more widely until the 20th century, when it was given more consistently to patients with respiratory failure. Strong clinical evidence supporting optimal respiratory care and ventilator support has accumulated over decades.

Numerous methods for ventilating patients are available in both invasive and noninvasive modes. However, patient-ventilator asynchrony has been a persistent problem. Patient-ventilator asynchrony occurs when the ventilator fails to detect the patient's breath or detects it too late in the breathing cycle, leading to complications that include increased sedation, discomfort, and possibly higher morbidity and mortality. Additionally, invasive mechanical ventilation causes alveolar overdistention, pulmonary air leaks, and small airway injuries.

Sinderby et al first described the concept of neural control of mechanical ventilation in 1999. The neurally adjusted ventilatory assist (NAVA) equipment detects the diaphragm's electrical activity or electromyographic signal by a specially placed orogastric or nasogastric catheter, which can reduce asynchrony and provide increased comfort and control of ventilation to patients. This mode may be used invasively and noninvasively, as in noninvasive ventilation-neurally adjusted ventilatory assist (NIV-NAVA).