Neurally-Adjusted Ventilatory Assist Versus Pressure Support Ventilation During Noninvasive Ventilation

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Mechanical Ventilation

Background:

• Noninvasive ventilation (NIV) is increasingly utilized for respiratory support.
• Neurally-adjusted ventilatory assist (NAVA) is a mechanical ventilation mode designed to enhance patient-ventilator synchrony.
• Pressure support ventilation (PSV) is a common alternative mode for NIV.

Purpose of the Study:

• To compare patient-ventilator interaction and clinical outcomes between NAVA and PSV during NIV in adult patients.
• To evaluate the effectiveness of NAVA in reducing asynchrony and improving patient comfort.

Main Methods:

• A meta-analysis was conducted, searching major databases for relevant clinical trials.
• Studies comparing NIV-NAVA with NIV-PSV in adult subjects were included.
• Key outcomes assessed included asynchrony index (AI), types of asynchrony, inspiratory trigger delay, ICU length of stay, and patient discomfort.

Main Results:

• Fifteen studies involving 615 subjects were analyzed.
• NAVA significantly reduced AI and severe asynchrony compared to PSV.
• NAVA demonstrated a significant reduction in inspiratory trigger delay.
• However, NAVA was associated with a longer ICU length of stay and increased patient discomfort.

Conclusions:

• NAVA offers superior patient-ventilator interaction compared to PSV in the context of NIV.
• Further investigation is warranted to fully elucidate the impact of NAVA on clinical outcomes.