The application and effect of neurally adjusted ventilatory assist

Abstract

Although mechanical ventilation is a life-saving intervention for the management of acute respiratory failure, it can cause complications such as ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction, adversely affecting the outcomes of critically ill patients. Hence, methods of implementing lung-and diaphragm-protective ventilation are currently a major topic of discussion in intensive care medicine. Unlike other modes of partial ventilator assistance, which adopt conventional pneumatic signals (flow, volume, and airway pressure) to drive and control the ventilator operation, neurally adjusted ventilatory assist (NAVA) uses the electrical activity of the diaphragm, which is the best signal for estimating the respiratory drive, to control triggering, cycling, and the magnitude of assistance. Based on this concept, NAVA has the ability to avoid over-and under-assistance, improve patient-ventilator interaction and synchrony, and potentially play a role in lung-and diaphragm-protective ventilation. However, it remains to be determined whether these advantages translate into improved clinical outcomes.