To report on the monitoring of diaphragm electrical activity (Edi) using neurally adjusted ventilator assist (NAVA) technology to investigate the mechanisms of ventilator dependence in children with neuromuscular and respiratory control disorders.
Patients and methods
Using NAVA technology, electrical activity of the diaphragm (Edi) was monitored at the lowest achievable level of respiratory support in six ventilator-dependent patients with neuromuscular and respiratory control disorders, aged 6 weeks to 12 years, admitted to a tertiary paediatric intensive care unit between 2009 and 2011.
Edi monitoring identified markedly abnormal respiratory dynamic patterns that were not always apparent clinically. These were associated with disorders of central respiratory control, muscle weakness and diaphragm pathology.
Edi monitoring using NAVA technology is a valuable, minimally invasive, diagnostic adjunct in children with neuromuscular and respiratory control disorders who are ventilator-dependent.
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Appendix: NAVA catheter positioning
Appendix: NAVA catheter positioning
As referenced in the main text, the NAVA catheter was positioned as previously described. The appropriately sized catheter was selected by the child’s age, as recommended by the manufacturer. The ‘NEX’ (nose-ear-xiphisternum) technique was used to estimate catheter length, and the correct position was confirmed by inspection of the four oesophageal ECG tracings, with the blue markers present in the two middle tracings [4, 5].
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Fine-Goulden, M.R., Puppala, N.K. & Durward, A. Mechanisms of ventilator dependence in children with neuromuscular and respiratory control disorders identified by monitoring diaphragm electrical activity. Intensive Care Med 38, 2072–2079 (2012). https://doi.org/10.1007/s00134-012-2724-8
- Neurally adjusted ventilator assist (NAVA)
- Ventilator asynchrony