| Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference. | |
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MedLine Citation:
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PMID: 22715815 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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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Authors:
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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 |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-6-20 |
Journal Detail:
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Title: Critical care (London, England) Volume: 16 ISSN: 1466-609X ISO Abbreviation: - Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-6-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9801902 Medline TA: Crit Care Country: - |
Other Details:
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Languages: ENG Pagination: 225 Citation Subset: - |
Affiliation:
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INSERM U1075, Caen F-14000, France. terzi-n@chu-caen.fr. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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