The Application of N.A.V.A. to pediatric patients

Introduction: Neural Adjusted Ventilatory Assist (NAVA) is a new mode of ventilation that was recently applied in the PICUs recently. NAVA provides a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort.

Aim: To review the recent international literature on the use of NAVA to patients, admitted to the Peadiatric Intensive Care Unit (PICU) and the impact of NAVA on respiratory and hemodynamic parameters, as well as on the outcome of these patients.

Material and Method: International bibliography was searched for studies published until August 2019 in the PUBMED database with the following keywords: "Neurally Adjusted Ventilator Assist" "ventilation", "Paediatric Intensive Care Unit", "Child" and "Infant”. The review included primary studies written in English concerning the application of NAVA to children admitted to the PICU.

Results: The initial search resulted in 58 articles, and after reading the title, abstract, and the overall text, 11 articles were included in the review. The application of NAVA to infants and children in the PICU was associated with a significant improvement in patient-ventilator synchronization, a reduction in peak and mean airway pressures, a reduction of oxygen concentration. Also, one study found that the amount of sedation was significantly lower when NAVA was applied to non-surgical patients. NAVA was also associated with a significantly higher COFMORT scale rating.

Conclusions: The application of NAVA appears to be safe for PICU patients, and well tolerated and improves patient-respirator synchronization. However, it is necessary to carry out randomized clinical trials with a larger sample of patients to confirm the results.

Keywords: Neurally Adjusted Ventilatory Assist, N.A.V.A., children intensive care unit