Intensive Care Medicine

, Volume 44, Issue 12, pp 2309–2311 | Cite as

Diaphragm myoclonus-induced autotriggering during neurally adjusted ventilatory assist

  • Luca Salvatore Menga
  • Giovanna Cammareri
  • Tamara Jovanovic
  • Antonio Maria Dell’Anna
  • Domenico Luca GriecoEmail author
  • Massimo Antonelli

Dear Editor,

Neurally adjusted ventilatory assist (NAVA) is activated by the electromyographic activity of the diaphragm (Edi) and delivers pressure-regulated respiratory support proportionally tailored to the patient’s neural effort. As compared to pressure support ventilation (PSV) and flow-based triggering systems, NAVA lowers trigger delay, limits the risk of over-assistance and improves patient–ventilator interaction [1, 2]. Little is known about how NAVA interacts with epileptic seizures.

An 85-year-old male patient with myasthenia gravis and chronic obstructive pulmonary disease was admitted to our intensive care unit due to viral meningoencephalitis with seizures and progressive neurological decay that led to intubation. Seizures were initially generalized and, after treatment (valproic acid 1.6 g/24 h and levetiracetam 3 g/24 h), became partial, mostly involving the right side of the body.

Early after intubation, the patient developed inhalation pneumonia, with lower left...


Compliance with ethical standards

Conflicts of interest

DLG has received payments for travel expenses by Maquet, Getinge and Air Liquide. MA has received payments for Board participation from Maquet, Air Liquide and Chiesi. All the other authors declare that no confict of interest exists regarding the material discussed in the manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Istituto di Anestesiologia e RianimazioneUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Scienze dell’emergenza, Anestesiologiche e della RianimazioneFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  3. 3.Department of Anesthesia and Intensive Care MedicineVittorio Emanuele University HospitalCataniaItaly

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