Application of neurally adjusted ventilatory assist in neonates

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.

Keywords: Diaphragm; Electrical activity; Neural trigger; Neurally adjusted ventilatory assist; Neuroventilatory cascade; Patient–ventilator interaction; Synchrony.

Publication types

  • Review

MeSH terms

  • Animals
  • Clinical Trials as Topic
  • Diaphragm / physiology
  • Electromyography
  • Humans
  • Infant
  • Infant, Newborn
  • Interactive Ventilatory Support / methods*
  • Interactive Ventilatory Support / standards
  • Neonatology / methods*
  • Neonatology / standards