Neurally adjusted ventilatory assist: Assessing the comfort and feasibility of use in neonates and children

Aim: To evaluate the practical feasibility for nurses working with neurally adjusted ventilatory assist (NAVA) and assess patient comfort and safety when NAVA is initiated. Background: NAVA is a relatively new mode of ventilation. Its application in neonates and children has been widely documented. However, its practical feasibility from a nursing point of view as well as its safety and comfort in these populations compared with conventional modes of ventilation has not been described. Design: A prospective, observational crossover pilot study. Method: NAVA was compared with the conventional mode of ventilation for 3 h each, and practical feasibility, patient comfort level and safety were assessed. Results: Twenty-one neonates and children were enrolled into the study. There were no reported adverse events. In most patients, the NAVA catheter was placed too shallow, as measured by the distances from the nose, ear, xiphisternum (NEX) method, according to the manufacturer's instructions. Accurate placement was confirmed by visual inspection of the NAVA positioning window. Patients' comfort did not differ between the conventional mode and NAVA. Conclusions: NAVA is feasible, once an accurate signal of the electrical activity of the diaphragm is achieved and seems safe and well tolerated in both neonates and children. Nurses need to gain experience in placing the NAVA catheter and practical recommendations are given. Relevance to clinical practice: NAVA is a promising new mode of ventilation. This article contributes to an increasing body of evidence that NAVA is feasible in neonates and children. There are practical considerations when NAVA is applied in these patient-groups.

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