Effectiveness and safety of Neurally Adjusted Ventilatory Assist (NAVA) mechanical ventilation compared to standard conventional mechanical ventilation in optimizing patient-ventilator synchrony in critically ill patients: a systematic review protocol.

Abstract

Review question/objective The objective of this systematic review is to systemically identify, appraise and synthesize the best available evidence regarding the safety and effectiveness of invasive mechanical ventilation in optimizing patient-ventilator interaction by using the Neurally Adjusted Ventilatory Assist compared with conventional invasive mechanical ventilation modalities in critically ill pediatric and adult patients in intensive care units. Does Neurally Adjusted Ventilatory Assist have a better capability in reducing patient-ventilator asynchrony compared to the conventional invasive mechanical ventilation among critically ill pediatric and adult patients on ventilator support in an intensive care environment? Is Neurally Adjusted Ventilatory Assist safer than the conventional invasive mechanical ventilation to be used in critically ill pediatric and adult patients in an intensive care environment? Inclusion criteria Types of participants This review will consider critically ill adult and pediatric patients across all demographic groups, with or without existing comorbidities and with any causes precipitating respiratory failure requiring invasive mechanical ventilation via endotracheal intubation and tracheostomized intubation in intensive care units. Types of intervention This review will consider studies that evaluate the safety and effectiveness of Neurally Adjusted Ventilatory Assist. Types of comparators This review will consider the studies that used standard conventional invasive mechanical ventilation as comparators for the intervention. The current standard invasive mechanical ventilation includes ventilators (modes) that use the automated closed-loop feedback mode, the pneumatic triggering modality, shape-signal triggering and high frequency oscillatory ventilation . For the purpose of this review the automated closed-loop feedback modes refer to the Smartcare/PM™, Adaptive Support Ventilation, Automode, Proportional Assist Ventilation, Mandatory Minute Ventilation, Proportional Pressure Support, Intellivent-ASV® and Mandatory Rate Ventilation; and the pneumatic triggering modality is defined as a mechanical ventilator that uses flow, volume or pressure to measure patient inspiratory effort. Types of outcomes This review will consider studies that include the following outcome measures: Primary outcomes: Incidence of Patient-ventilator asynchrony: can be detected by measurement of electrical activity of respiratory muscles (diaphragm or transverse abdominus) or esophageal pressure, or ventilator graphic waveforms, and as defined and measured in the included studies. Length of TRUNCATED AT 350 WORDS