Department of Neonatology, Toledo Children's Hospital, Toledo, OH 43606, USA.
Department of Neonatology, Akron Children's Hospital, Akron, OH 44308, USA.
Semin Fetal Neonatal Med. 2014 Feb;19(1):60-9. doi: 10.1016/j.siny.2013.09.005. Epub 2013 Nov 13.
Neurally adjusted ventilatory assist (NAVA) uses the electrical activity of the diaphragm (Edi) as a neural trigger to synchronize mechanical ventilatory breaths with the patient's neural respiratory drive. Using this signal enables the ventilator to proportionally support the patient's instantaneous drive on a breath-by-breath basis. Synchrony can be achieved even in the presence of significant air leaks, which make this an attractive choice for invasive and non-invasive ventilation of the neonate. This paper describes the Edi signal, neuroventilatory coupling, and patient-ventilator synchrony including the functional concept of NAVA. Safety features, NAVA terminology, and clinical application of NAVA to unload respiratory musculature are presented. The use of the Edi signal as a respiratory vital sign for conventional ventilation is discussed. The results of animal and adult studies are briefly summarized and detailed descriptions of all NAVA-related research in pediatric and neonatal patients are provided. Further studies are needed to determine whether NAVA will have significant impact on the overall outcomes of neonates.
神经调节辅助通气（NAVA）使用膈肌的电活动（Edi）作为神经触发信号，使机械通气与患者的神经呼吸驱动同步。使用该信号可以使呼吸机在逐次呼吸的基础上按比例支持患者的即时驱动。即使存在明显的漏气，同步也可以实现，这使得 NAVA 成为新生儿有创和无创通气的理想选择。本文描述了 Edi 信号、神经通气耦联和患者-呼吸机同步，包括 NAVA 的功能概念。介绍了安全性特征、NAVA 术语以及 NAVA 对呼吸肌的卸载作用在临床中的应用。讨论了将 Edi 信号用作常规通气的呼吸生命体征。简要总结了动物和成人研究的结果，并详细描述了儿科和新生儿患者的所有 NAVA 相关研究。需要进一步的研究来确定 NAVA 是否会对新生儿的整体预后产生重大影响。
