Skip to main content

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2011 ((AUICEM,volume 1))

  • 2126 Accesses

Abstract

This chapter is written in an attempt to document some of the reasons behind the development of the ventilatory mode known as neurally-adjusted ventilatory assist (NAVA).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ricard JD, Dreyfuss D, Saumon G (2002) Ventilator-induced lung injury. Curr Opin Crit Care 8: 12–20

    Article  PubMed  Google Scholar 

  2. Moloney ED, Griffiths MJ (2004) Protective ventilation of patients with acute respiratory distress syndrome. Br J Anaesth 92: 261–270

    Article  PubMed  CAS  Google Scholar 

  3. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342: 1301–1308

    Article  Google Scholar 

  4. Griffiths RD, Hall JB (2010) Intensive care unit-acquired weakness. Crit Care Med 38: 779–787

    Article  PubMed  Google Scholar 

  5. Tobin MJ, Laghi F, Jubran A (2010) Narrative review: ventilator-induced respiratory muscle weakness. Ann Intern Med 153: 240–245

    PubMed  Google Scholar 

  6. Vassilakopoulos T (2008) Ventilator-induced diaphragm dysfunction: the clinical relevance of animal models. Intensive Care Med 34: 7–16

    Article  PubMed  CAS  Google Scholar 

  7. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC (2010) Ventilator-associated pneumonia: A review. Eur J Intern Med 21: 360–368

    Article  PubMed  Google Scholar 

  8. Feng Y, Amoateng-Adjepong Y, Kaufman D, Gheorghe C, Manthous CA (2009) Age, duration of mechanical ventilation, and outcomes of patients who are critically ill. Chest 136: 759–764

    Article  PubMed  Google Scholar 

  9. Wunsch H, Linde-Zwirble WT, Angus DC, Hartman ME, Milbrandt EB, Kahn JM. (2010) The epidemiology of mechanical ventilation use in the United States. Crit Care Med 38: 1947–1953

    PubMed  Google Scholar 

  10. Sassoon CS, Zhu E, Caiozzo VJ. (2004) Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med 170: 626–632

    Article  PubMed  Google Scholar 

  11. Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342: 1471–1477

    Article  PubMed  CAS  Google Scholar 

  12. Treggiari MM, Romand JA, Yanez ND, et al (2009) Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 37: 2527–2534

    Article  PubMed  Google Scholar 

  13. Hall JB, Schweickert W, Kress JP (2009) Role of analgesics, sedatives, neuromuscular blockers, and delirium. Crit Care Med 37(10 Suppl): S416–421

    Article  PubMed  Google Scholar 

  14. Esteban A, Frutos F, Tobin MJ, et al (1995) A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 332: 345–350

    Article  PubMed  CAS  Google Scholar 

  15. Ely EW, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335: 1864–1869

    Article  PubMed  CAS  Google Scholar 

  16. Girard TD, Kress JP, Fuchs BD, et al (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371: 126–134

    Article  PubMed  Google Scholar 

  17. Strøm T, Martinussen T, Toft P (2010) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 375: 475–480

    Article  PubMed  Google Scholar 

  18. Gianoulli E, Webster K, Roberts D, Younes M (1999) Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med 159: 1716–1725

    Google Scholar 

  19. Aslanian P, El Atrous S, Isabey D, et al (1998) Effects of flow triggering on breathing effort during partial ventilatory support. Am J Respir Crit Care Med 157: 135–143

    PubMed  CAS  Google Scholar 

  20. Leung P, Jubran A, Tobin MJ (1997) Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea. Am J Respir Crit Care Med 155: 1940–1948

    PubMed  CAS  Google Scholar 

  21. Spahija J, de Marchie M, Albert M, et al (2010) Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 38: 518–526

    Article  PubMed  Google Scholar 

  22. de Wit M, Pedram S, Best AM, Epstein SK (2009) Observational study of patient-ventilator asynchrony and relationship to sedation level. J Crit Care 24: 74–80

    Article  PubMed  Google Scholar 

  23. Calderini E, Confalonieri M, Puccio PG, et al (1999) Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intensive Care Med 25: 662–667

    Article  PubMed  CAS  Google Scholar 

  24. Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32: 1515–1522.

    Article  PubMed  Google Scholar 

  25. Colombo D, Cammarota G, Bergamaschi V, De Lucia M, Corte FD, Navalesi P (2008) Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 34: 2010–2018

    Article  PubMed  Google Scholar 

  26. de Wit M, Miller KB, Green DA, Ostman HE, Gennings C, Epstein SK (2009) Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med 37: 2740–2745

    Article  PubMed  Google Scholar 

  27. Vignaux L, Vargas F, Roeseler J, et al (2009) Patient-ventilator asynchrony during noninvasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med 35: 840–846

    Article  PubMed  Google Scholar 

  28. Sinderby C, Brander L, Beck J (2009) Bedside monitoring of diaphragm electrical activity during mechanical ventilation. In: Vincent JL (ed) Yearbook of Intensive Care Medicine. Springer Verlag, Germany, pp 385–393

    Chapter  Google Scholar 

  29. Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M (1997) Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 112: 1592–1599

    Article  PubMed  CAS  Google Scholar 

  30. Laghi F, Cattapan SE, Jubran A, et al (2003) Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 167: 120–127

    Article  PubMed  Google Scholar 

  31. Watson AC, Hughes PD, Louise Harris M, et al (2001) Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med 29: 1325–1331

    Article  PubMed  CAS  Google Scholar 

  32. Hermans G, Agten A, Testelmans D, Decramer M, Gayan-Ramirez G (2010) Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. Crit Care 14: R127

    Article  PubMed  Google Scholar 

  33. Levine S, Nguyen T, Taylor N, et al (2008) Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 358: 1327–1335

    Article  PubMed  CAS  Google Scholar 

  34. Callahan LA, Supinski GS (2010) Diaphragm weakness and mechanical ventilation — what’s the critical issue? Crit Care 14: 187

    Article  PubMed  Google Scholar 

  35. Sassoon CSh, Caiozzo VJ. (2009) Bench-to-bedside review: Diaphragm muscle function in disuse and acute high-dose corticosteroid treatment. Crit Care 13: 221

    Article  PubMed  Google Scholar 

  36. Sinderby C, Navalesi P, Beck J, et al (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5: 1433–1436

    Article  PubMed  CAS  Google Scholar 

  37. Aldrich T, Sinderby C, McKenzie D, Estenne M, Gandevia S (2002) Electrophysiologic techniques for the assessment of respiratory muscle function. In: the ATS/ERS Statement on Respiratory Muscle Testing. Am J Respir Crit Care Med 166: 548–558

    Google Scholar 

  38. Moerer O, Beck J, Brander L, et al (2008) Subject-ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Med 34: 1615–1623

    Article  PubMed  Google Scholar 

  39. Terzi N, Pelieu I, Guittet L, et al (2010) Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: physiological evaluation. Crit Care Med 38: 1830–1837

    Article  PubMed  Google Scholar 

  40. Wu XY, Huang YZ, Yang Y, Liu SQ, Liu HG, Qiu HB (2009) Effects of neurally adjusted ventilatory assist on patient-ventilator synchrony in patients with acute respiratory distress syndrome. Zhonghua Jie He He Hu Xi Za Zhi 32: 508–512

    PubMed  Google Scholar 

  41. Beck J, Reilly M, Grasselli G, et al (2009) Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants. Pediatr Res 65: 663–668

    Article  PubMed  Google Scholar 

  42. Zhu LM, Shi ZY, Ji G, et al (2009) Application of neurally adjusted ventilatory assist in infants who underwent cardiac surgery for congenital heart disease]. Zhongguo Dang Dai Er Ke Za Zhi 11: 433–436

    PubMed  Google Scholar 

  43. Zhu LM, Xu ZM, Ji G, et al (2010) Effect of prone or spine position on mechanically ventilated neonates after cardiac surgery with acute lung injury. Zhonghua Yi Xue Za Zhi 90: 1260–1263

    PubMed  Google Scholar 

  44. Breatnach C, Conlon NP, Stack M, Healy M, O’Hare BP (2010) A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population. Pediatr Crit Care Med 11: 7–11

    Article  PubMed  Google Scholar 

  45. Younes M (1992) Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 145: 114–120

    PubMed  CAS  Google Scholar 

  46. Sinderby C, Beck J (2008) Proportional assist ventilation and neurally adjusted ventilatory assist—better approaches to patient ventilator synchrony? Clin Chest Med 29: 329–342

    Article  PubMed  Google Scholar 

  47. Allo JC, Beck JC, Brander L, Brunet F, Slutsky AS, Sinderby CA (2006) Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med 34: 2997–3004

    PubMed  Google Scholar 

  48. Lecomte F, Brander L, Jalde F, et al (2009) Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA). Respir Physiol Neurobiol 166: 117–124

    Article  PubMed  Google Scholar 

  49. Beck J, Campoccia F, Allo JC, Brander L, Brunet F, Slutsky AS, Sinderby C (2007) Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits. Pediatr Res 61: 289–294

    Article  PubMed  Google Scholar 

  50. Brander L, Leong-Poi H, Beck J, et al (2009) Titration and implementation of neurally adjusted ventilatory assist in critically ill patients. Chest 135: 695–703

    Article  PubMed  Google Scholar 

  51. Sinderby C, Beck J, Spahija J, et al (2007) Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest 131: 711–717

    Article  PubMed  Google Scholar 

  52. Schmidt M, Demoule A, Cracco C, et al (2010) Neurally adjusted ventilatory assist increases respiratory variability and complexity in acute respiratory failure. Anesthesiology 112: 670–681

    Article  PubMed  Google Scholar 

  53. Coisel Y, Chanques G, Jung B, et al (2010) Neurally adjusted ventilatory assist in critically ill postoperative patients: A crossover randomized study. Anesthesiology 113: 925–935

    Article  PubMed  Google Scholar 

  54. Loring SH, Malhotra A (2007) Inspiratory efforts during mechanical ventilation: is there risk of barotrauma? Chest 131: 646–648

    Article  PubMed  Google Scholar 

  55. Leiter JC, Manning HL (2010) The Hering-Breuer reflex, feedback control, and mechanical ventilation: the promise of neurally adjusted ventilatory assist. Crit Care Med 38: 1915–1916

    Article  PubMed  CAS  Google Scholar 

  56. Karagiannidis C, Lubnow M, Philipp A, et al (2010) Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med 36: 2038–2044

    Article  PubMed  Google Scholar 

  57. Brander L, Sinderby C, Lecomte F, et al (2009) Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury. Intensive Care Med 35: 1979–1789

    Article  PubMed  Google Scholar 

  58. Brochard L, Thille AW (2009) What is the proper approach to liberating the weak from mechanical ventilation? Crit Care Med 37(10 Suppl): S410–415

    Article  PubMed  Google Scholar 

  59. Passath C, Takala J, Tuchscherer D, Jakob SM, Sinderby C, Brander L (2010) Physiologic response to changing positive end-expiratory pressure during neurally adjusted ventilatory assist in sedated, critically ill adults. Chest 138: 578–587

    Article  PubMed  Google Scholar 

  60. Bengtsson JA, Edberg KE (2010) Neurally adjusted ventilatory assist in children: an observational study. Pediatr Crit Care Med 11: 253–257

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Sinderby, C., Beck, J. (2011). NAVA: Why, When, Who?. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2011. Annual Update in Intensive Care and Emergency Medicine 2011, vol 1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18081-1_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-18081-1_16

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-18080-4

  • Online ISBN: 978-3-642-18081-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics