Physiologic response to changing positive end-expiratory pressure during neurally adjusted ventilatory assist in sedated, critically ill adults.

@article{Passath2010PhysiologicRT,
  title={Physiologic response to changing positive end-expiratory pressure during neurally adjusted ventilatory assist in sedated, critically ill adults.},
  author={Christina Passath and Jukka Takala and Daniel Tuchscherer and Stephan M. Jakob and Christer Sinderby and Lukas Brander},
  journal={Chest},
  year={2010},
  volume={138 3},
  pages={
          578-87
        }
}
BACKGROUND Neurally adjusted ventilatory assist (NAVA) delivers airway pressure (Paw) in proportion to neural inspiratory drive as reflected by electrical activity of the diaphragm (EAdi). Changing positive end-expiratory pressure (PEEP) impacts respiratory muscle load and function and, hence, EAdi. We aimed to evaluate how PEEP affects the breathing pattern and neuroventilatory efficiency during NAVA. METHODS In 20 adult patients, adequate assist (NAVAal) was first identified based on Paw… 
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Effects of Neurally Adjusted Ventilatory Assist (NAVA) levels in non-invasive ventilated patients: titrating NAVA levels with electric diaphragmatic activity and tidal volume matching
TLDR
The patient-specific matching between ʃEadi and Vt was variable, indicating that to obtain the best possible matching, NAVA level setting should be patient specific.
Feasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental lung injury
TLDR
Continuous NAVA was able to apply neurally adjusted PEP, which led to a reduction in inspiratory effort compared to triggered NAVA, and may aid in delivering a “neurally adjusted PEEP”, and more specific breath-by-breath unloading.
Effect of changing NAVA levels on peak inspiratory pressures and electrical activity of the diaphragm in premature neonates
TLDR
Neonates demonstrated a BrP suggesting intact neural feedback mechanisms that may protect lungs from over distention with NAVA ventilation, suggesting intact neurons allowing them to have a breakpoint (BrP).
Physiologic response to various levels of pressure support and NAVA in prolonged weaning.
Heart–lung interactions during neurally adjusted ventilatory assist
TLDR
Right ventricular performance is less impaired during NAVA compared to PSV as used in this study, and proposed mechanisms are preservation of cyclic intrathoracic pressure changes characteristic of spontaneous breathing and limitation of right-ventricular outflow impedance during inspiration, regardless of the NAVA level.
Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist.
TLDR
In patients after respiratory failure and prolonged mechanical ventilation, changes in VT and NVE, between SBTs are indicative of patient recovery, and larger clinical trials are needed to clarify whether changes in NVE reliably predict weaning in patients ventilated with NAVA.
Clinical Assessment of Auto-positive End-expiratory Pressure by Diaphragmatic Electrical Activity during Pressure Support and Neurally Adjusted Ventilatory Assist
TLDR
In patients with auto-PEEP, NAVA, compared with pressure support ventilation, led to a decrease in the pressure necessary to overcome auto- PEEP, which could be reliably monitored by the electrical activity of the diaphragm before inspiratory flow onset (auto-EAdi).
The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome
TLDR
This study shows that injurious phenomena like R/D and high PTP are present in NAVA at the two extremes of the PEEP spectrum, and the physician must choose the best compromise between restraining the R/ D or PTP.
NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand
TLDR
NAVA provided better matching of Vt to ʃEadi for 21 of 22 patients, and provided greater variability Vt, regardless of differences in ventilatory demand (Eadi) between patients and modes.
Pressure Support Ventilation (PSV) versus Neurally Adjusted Ventilatory Assist (NAVA) in difficult to wean pediatric ARDS patients: a physiologic crossover study
TLDR
In this specific PICU population, presenting difficulty in weaning after PARDS, NAVA was associated with a reduction of the AI and a significant improvement in oxygenation compared to PSV mode.
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References

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TLDR
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Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA)
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TLDR
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TLDR
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