Neutrally Adjusted Ventilatory Assist (NAVA) is a mode of mechanical ventilation that synchronizes with the patient's own respiratory efforts. This is achieved by detecting the electrical activity of the diaphragm (Edi) through an esophageal catheter. NAVA is unique because it allows the patient to regulate their own breathing, providing support proportional to their respiratory drive.
NAVA operates by measuring the Edi signal, which represents the neural respiratory drive. This signal is then used to control the ventilator, providing support in proportion to the patient's inspiratory efforts. This method can improve synchrony between the patient and the ventilator, potentially reducing the work of breathing and improving comfort.
Children, especially neonates, often have unique and variable respiratory needs. Traditional modes of mechanical ventilation can sometimes lead to issues such as
ventilator-induced lung injury or asynchronous breathing patterns. NAVA offers a more personalized approach, adjusting in real-time to the child's needs, which can be particularly beneficial for
preterm infants with immature lungs.
Several benefits make NAVA an appealing option in pediatric care:
Improved Synchrony: By aligning with the child's own respiratory efforts, NAVA can reduce the risk of ventilator-induced injury.
Comfort: Children may find NAVA more comfortable as the support is more natural and less intrusive.
Reduced Sedation: Better synchronization often means less need for sedation, which is particularly important in pediatric care.
Enhanced Monitoring: The Edi signal provides valuable information about the patient's respiratory drive and effort, aiding in more precise management.
While NAVA has many advantages, there are also some considerations:
Technical Challenges: Proper placement and maintenance of the esophageal catheter can be challenging, especially in smaller patients.
Cost: NAVA systems can be more expensive than traditional ventilators.
Training: Healthcare providers need specific training to use NAVA effectively, which may limit its immediate availability in some settings.
Clinical Applications
NAVA can be used in various clinical scenarios in pediatrics, including:
Conclusion
NAVA represents a significant advancement in the field of pediatric mechanical ventilation. By aligning ventilatory support with the patient's own respiratory efforts, it offers a more natural, comfortable, and potentially safer method of ventilation. However, the successful implementation of NAVA requires careful consideration of technical, financial, and training aspects. As with any medical intervention, the choice of ventilation mode should be individualized to the patient's specific needs and the clinical setting.
