Neurally-adjusted ventilatory assist (NAVA) in children: a systematic review.

INTRODUCTION: Application of mechanical ventilation in spontaneously breathing children remains a challenge for several reasons: mainly, small tidal volumes and high respiratory rates, especially in the presence of leaks, interfere with patient-ventilator synchrony. Leaks also cause unreliable monitoring of respiratory drive and respiratory rate. Furthermore, ventilator adjustment must take into account that infants have strong vagal reflexes, demonstrate central apnea and periodic breathing, with a high variability in breathing pattern. Neurally-adjusted ventilatory assist (NAVA) is a mode of ventilation whereby the timing and amount of ventilatory assist is controlled by the patient's neural respiratory drive. Since NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized assist, both invasively and non-invasively (NIV-NAVA), to follow the variability in breathing pattern, and to monitor patient respiratory drive, independent of leaks. EVIDENCE ACQUISITION: This article provides a review of the scientific literature pertaining to the use of NAVA in children (neonatal and pediatric age groups). Both the invasive and non-invasive NAVA publications are summarized, as well as the use of Edi monitoring. EVIDENCE SYNTHESIS: Overall, the use of NAVA and Edi monitoring is feasible and safe. Compared to conventional ventilation, NAVA improves patient-ventilator interaction, and provides lower peak inspiratory pressure. CONCLUSIONS: Evidence from a few trials suggests improved comfort, less sedation, and reduced length of stay.