Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation during weaning A meta-analysis of randomized trials

Background: Prolonged ventilatory support is associated with poor clinical outcomes. Pressure support ventilation modes, are frequently used in clinical practice but are associated with patient–ventilator asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient–ventilator asynchrony compared with other partial support modes for patients with difficult weaning. Objectives: To conduct a meta-analysis comparing neurally adjusted ventilatory assist (NAVA) with pressure support ventilation (PSV), in adult ventilated patients & clinical outcomes. Study design: Meta-analysis was used to address this concern. Sittings: Meta-analysis-based study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Methods: Online databases (PubMed, Embase, BioMed, and the Cochrane Central Register of Controlled trials)- were used for randomized studies ever performed in humans with NAVA & PSV in any clinical setting. Results: Twelve studies (n = 799 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with pressure support ventilation. For the secondary outcomes, NAVA may reduce duration of mechanical ventilation and hospital mortality and prolongs ventilator-free days when compared with other modes. Conclusion: Our study suggests that the (NAVA) mode may improve the rate of weaning success compared with pressure support ventilation for difficult weaning