Sheng Yuliang, Shao Wei, Wang Yuhao, Kang Xiuwen, Hu Rong
Department of Respiratory and Critical Care Medicine, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, Jiangsu, China.
Jinzhou Medical University, Jinzhou 121000, Liaoning, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Nov;35(11):1229-1232. doi: 10.3760/cma.j.cn121430-20230222-00101.
Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to diverse modes of assisted ventilation. Conventional mechanical ventilators depend on flow sensors and pneumatic pressure and controllers to complete the respiratory cycle. Neurally adjusted ventilatory assist (NAVA) is a new form of assisted ventilation in recent years, which monitors the electrical activity of the diaphragm (EAdi) to provide an appropriately level of pressure support. And EAdi is the best available signal to sense central respiratory drive and trigger ventilatory assist. Unlike other ventilation modes, NAVA breathing instructions come from the center. Therefore, NAVA have the synchronous nature of the breaths and the patient-adjusted nature of the support. Compared with traditional ventilation mode, NAVA can efficiently unload respiratory muscles, relieve the risk of ventilator-induced lung injury (VILI), improve patient-ventilator coordination, enhance gas exchange, increase the success rate of weaning, etc. This article reviews the research progress of NAVA in order to provide theoretical guidance for clinical applications.
自从机械通气引入临床实践以来,它已从控制通气经历了重大演变,发展为多种辅助通气模式。传统的机械通气机依靠流量传感器、气压和控制器来完成呼吸周期。神经调节通气辅助(NAVA)是近年来一种新型的辅助通气方式,它通过监测膈肌的电活动(EAdi)来提供适当水平的压力支持。并且EAdi是感知中枢呼吸驱动和触发通气辅助的最佳可用信号。与其他通气模式不同,NAVA的呼吸指令来自中枢。因此,NAVA具有呼吸同步性和支持的患者调节性。与传统通气模式相比,NAVA可有效减轻呼吸肌负荷,降低呼吸机诱导性肺损伤(VILI)风险,改善患者与呼吸机的协调性,增强气体交换,提高撤机成功率等。本文综述了NAVA的研究进展,以便为临床应用提供理论指导。