Robin McKinney, MD, on NAVA Use in Severe Bronchopulmonary Dysplasia

Robin McKinney, MD, explains what neurally adjusted ventilatory assist (NAVA) is, the research around its use in children and adults, and what this all means for clinical practice.

Robin L. McKinney, MD, is a pediatric intensivist at Hasbro Children's Hospital and an assistant professor of pediatrics at Brown University in Providence, Rhode Island.

References:

1. Lee J, Kim HS, Jung YH, Choi CW, Jun YH. Neurally adjusted ventilatory assist for infants under prolonged ventilation. Pediatr Int. 2017;59(5):540-544. https://doi.org/10.1111/ped.13233.
2. Jung YH, Kim HS, Lee J, Shin SH, Kim EK, Choi JH. Neurally adjusted ventilatory assist in preterm infants with established or evolving bronchopulmonary dysplasia on high-intensity mechanical ventilatory support. Pediatr Crit Care Med. 2016;17(12):1142-1146. https://doi.org/10.1097/PCC.0000000000000981.
3. Sinderby C, Beck J. Neurally adjusted ventilatory assist (NAVA): an update and summary of experiences. Neth J Crit Care. 2007;11(5):243-252. https://nvic.nl/sites/nvic.nl/files/pdf/2007_NJCC_05%20Sinderby.pdf.
4. Emeriaud G, Beck J, Tucci M, Lacroix J, Sinderby C. Diaphragm electrical activity during expiration in mechanically ventilated infants. Pediatr Res. 2006;59(5):705-710. https://doi.org/10.1203/01.pdr.0000214986.82862.57.
5. Passath C, Takala J, Tuchscherer D, Jakob SM, Sinderby C, Brander L. Physiologic response to changing positive end-expiratory pressure during neurally adjusted ventilatory assist in sedated, critically ill adults. Chest. 2010;138(3):578-587. https://doi.org/10.1378/chest.10-0286.
6. Piastra M, De Luca D, Costa R, et al. Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: nested study. J Crit Care. 2014;29(2):312.e1-5. https://doi.org/10.1016/j.jcrc.2013.08.006.
7. Lee J, Kim HS, Jung YH, et al. Non-invasive neurally adjusted ventilatory assist in preterm infants: a randomised phase II crossover trial. Arch Dis Child Fetal Neonatal Ed. 2015;100(6):F507-F513. https://doi.org/10.1136/archdischild-2014-308057.
8. Kallio M, Koskela U, Peltoniemi O, et al. Neurally adjusted ventilatory assist (NAVA) in preterm newborn infants with respiratory distress syndrome—a randomized controlled trial. Eur J Pediatr. 2016;175(9):1175-1183. https://doi.org/10.1007/s00431-016-2758-y.
9. Rossor TE, Huny KA, Shetty S, Greenough A. Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonatal respiratory support. Cochrane Database Syst Rev. 2017;10:CD012251. https://doi.org/10.1002/14651858.CD012251.pub2.
10. Rosterman JL, Pallotto EK, Truog WE, et al. The impact of neurally adjusted ventilatory assist mode on respiratory severity score and energy expenditure in infants: a randomized crossover trial. J Perinatol. 2018;38(1):59-63. https://doi.org/10.1038/jp.2017.154.
11. Pettenuzzo T, Aoyama H, Englesakis M, Tomlinson G, Fan E. Effect of neurally adjusted ventilator assist on patient-ventilator interaction in mechanically ventilated adults: a systematic review and meta-analysis [published online March 15, 2019]. Crit Care Med. https://doi.org/10.1097/CCM.0000000000003719.