Related Experiment Video
Updated: Nov 9, 2025
Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
Published on: July 14, 2023
Neurally Adjusted Ventilator Assist in Infants With Acute Respiratory Failure: A Literature Scoping Review
Julia Harris1,2, Shane M Tibby3, Ruth Endacott2,4
1Department of Advanced and Integrated Practice, London South Bank University, London, United Kingdom.
Insights
Evidence for neurally adjusted ventilatory assist (NAVA) in infants with respiratory failure is limited. Standardized strategies for NAVA and sedation are lacking, necessitating further robust research for clinical recommendations.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Acute respiratory failure is a critical condition in infants.
- Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation.
- Optimizing NAVA and sedation in infants requires clear evidence-based guidelines.
Purpose of the Study:
- To map existing evidence on NAVA strategies, outcomes, and sedation in infants (<12 months) with acute respiratory failure.
- To identify gaps in the literature regarding NAVA implementation in this population.
- To guide future research directions for improved infant respiratory support.
Main Methods:
- Systematic scoping review following PRISMA-ScR guidelines.
- Comprehensive search of multiple databases and trial registers.
- Inclusion of 15 articles, including primary research and expert opinions, with data extraction for infants.
Main Results:
- Limited evidence exists for NAVA strategies and specific conditions in infants.
- Inconsistent NAVA level settings and lack of optimization documentation.
- Variable outcome measures, predominantly respiratory and physiological, and inconsistent sedation practices.
Conclusions:
- Significant lack of standardized NAVA strategies and sedation practices for infants with acute respiratory failure.
- Studies are limited by small sample sizes and lack of focus on specific infant groups.
- Robust research is essential to develop evidence-based clinical recommendations for NAVA in infants.
Objectives:
To map the evidence for neurally adjusted ventilatory assist strategies, outcome measures, and sedation practices in infants less than 12 months with acute respiratory failure using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidance.
Data Sources:
CINAHL, MEDLINE, COCHRANE, JBI, EMBASE, PsycINFO, Google scholar, BNI, AMED. Trial registers included the following: ClinicalTrials.gov, European Union clinical trials register, International Standardized Randomized Controlled Trial Number register. Also included were Ethos, Grey literature, Google, dissertation abstracts, EMBASE conference proceedings.
Study Selection:
Abstracts were screened followed by review of full text. Articles incorporating a heterogeneous population of both infants and older children were assessed, and where possible, data for infants were extracted. Fifteen articles were included. Ten articles were primary research: randomized controlled trial (n = 3), cohort studies (n = 4), retrospective data analysis (n = 2), case series (n = 1). Other articles are expert opinion (n = 2), neurally adjusted ventilatory assist updates (n = 1), and a literature review (n = 2). Three studies included exclusively infants. We also included 12 studies reporting jointly on infants and children.
Data Extraction:
A standardized data extraction tool was used.
Data Synthesis:
Key findings were that evidence related to neurally adjusted ventilatory assist ventilation strategies in infants and related to specific primary conditions is limited. The setting of neurally adjusted ventilatory assist level is not consistent, and how to optimize this mode of ventilation was not documented. Outcome measures varied considerably, most studies focused on improvements in respiratory and physiological variables. Sedation use is variable with regard to medication type and dose. There is an indication that less sedation is required in patients receiving neurally adjusted ventilatory assist, but no conclusive evidence to support this.
Conclusions:
This review highlights a lack of standardized strategies for neurally adjusted ventilatory assist ventilation and sedation practices among infants with acute respiratory failure. Studies were limited by small sample sizes and a lack of focus on specific patient groups. Robust studies are needed to provide evidence-based clinical recommendations for the use of neurally adjusted ventilatory assist in infants with acute respiratory failure.
More Related Videos
06:22Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
08:58Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
Published on: October 31, 2025
Related Concept Videos
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:29Mechanical Ventilation I: Indication and Settings
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...