Impact of ventilatory modes on the breathing variability in mechanically ventilated infants: a commentary.

Abstract

Neurally adjusted ventilator assist (NAVA) ventilation is a mode of ventilation that is triggered and cycled by a signal from the electrical activity of the diaphragm (EAdi) to provide a positive pressure breath. The EAdi signal is obtained from an esophageal catheter that is positioned at the level of the diaphragm. The rational of this mode of ventilation is to improve patient–ventilator interaction by matching ventilator support to patient’s demand and therefore avoiding hyperventilation and air trapping, and impairment of cardiac output (1). Several studies have shown that NAVA is better tolerated than other modes of mechanical ventilation in infants and children. For instance, premature infants require a lower peak inspiratory pressure (PiP) and a lower fraction of inspired oxygen (FiO2) and they have a better blood gas regulation at a lower respiratory rate when ventilated with NAVA instead of pressure control (PC) (2). Furthermore, premature infants have a reduction in their respiratory muscle load and a lower PiP when ventilated with NAVA instead of synchronized intermittent mandatory ventilation (SIMV) with pressure support (PS) (3). Also, critically ill children are more comfortable when ventilated with NAVA instead of PS. They have a better synchronization with the ventilator, a reduction in their ventilatory drive, and an increase in breath to breath variability while on NAVA (4).