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Critical Care
Erschienen in: Critical Care 3/2012

01.06.2012 | Review

Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference

verfasst von: Nicolas Terzi, Lise Piquilloud, Hadrien Rozé, Alain Mercat, Frédéric Lofaso, Stéphane Delisle, Philippe Jolliet, Thierry Sottiaux, Didier Tassaux, Jean Roesler, Alexandre Demoule, Samir Jaber, Jordi Mancebo, Laurent Brochard, Jean-Christophe Marie Richard

Erschienen in: Critical Care | Ausgabe 3/2012

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Abstract

Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe. In clinical settings, NAVA has been chiefly compared with pressure-support ventilation, one of the most popular modes used during the weaning phase, which delivers a constant pressure from breath to breath. Comparisons with proportional-assist ventilation, which has numerous similarities, are lacking. Because of the constant level of assistance, pressure-support ventilation reduces the natural variability of the breathing pattern and can be associated with asynchrony and/or overinflation. The ability of NAVA to circumvent these limitations has been addressed in clinical studies and is discussed in this report. Although the underlying concept is fascinating, several important questions regarding the clinical applications of NAVA remain unanswered. Among these questions, determining the optimal NAVA settings according to the patient's ventilatory needs and/or acceptable level of work of breathing is a key issue. In this report, based on an investigator-initiated round table, we review the most recent literature on this topic and discuss the theoretical advantages and disadvantages of NAVA compared with other modes, as well as the risks and limitations of NAVA.
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Metadaten
Titel
Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference
verfasst von
Nicolas Terzi
Lise Piquilloud
Hadrien Rozé
Alain Mercat
Frédéric Lofaso
Stéphane Delisle
Philippe Jolliet
Thierry Sottiaux
Didier Tassaux
Jean Roesler
Alexandre Demoule
Samir Jaber
Jordi Mancebo
Laurent Brochard
Jean-Christophe Marie Richard
Publikationsdatum
01.06.2012
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 3/2012
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11297

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