Optimizing synchronized non-invasive support: Clinical management guidelines for non-invasive neurally adjusted ventilatory assist

Abstract

Neurally Adjusted Ventilatory Assist (NAVA) is an innovative ventilation mode that empowers patients to control both the timing and level of ventilatory support. By utilizing the electrical activity of the diaphragm (Edi) as the control signal, NAVA enables synchronized non-invasive ventilation (NIV-NAVA) even in the presence of leaks, while also providing continuous monitoring of the patient's respiratory pattern and drive. NIV-NAVA offers several advantages compared to conventional non-invasive ventilation, including enhanced patient-ventilator interaction and synchrony, reliable respiratory monitoring, and self-regulation of respiratory support. These features make NIV-NAVA theoretically ideal for providing effective and tailored non-invasive support to newborns with respiratory insufficiency. In clinical practice, NIV-NAVA has been successfully employed in neonates to prevent intubation, facilitate early extubation, and deliver nasal continuous positive airway pressure in a novel manner. Set up and management of NAVA has unique differences from conventional ventilation and an understanding of these is essential for successful NAVA ventilation. The efficacy of this approach in neonatal care is supported by numerous studies and clinical experiences with NIV-NAVA, demonstrating its potential to improve outcomes for infants with respiratory challenges.