Application of neurally adjusted ventilatory assist (NAVA): a narrative review

The neurally adjusted ventilatory assist (NAVA) operates by tracking the electrical activity of the diaphragm, known as diaphragm electrical activity (E_Adi), which serves as a crucial indicator of respiratory effort. As this innovative technology has continuously evolved over the years, its application in clinical settings has expanded significantly, leading to a broader acceptance and utilization among healthcare professionals. The primary purpose of this article is to consolidate and synthesize prior research findings concerning the interplay between NAVA and E_Adi, providing a comprehensive overview of their implications in patient care.

PubMed was searched for research from its establishment to December 31, 2024. Keywords included "NAVA", "neurally adjusted ventilatory assist", "diaphragm electrical activity (E_Adi)", "patient-ventilator synchrony", "E_Adi", "over-assistance", "weaning", "liberate", "sedation", "neurogenic ventilation efficiency", "neuromuscular efficiency", and "NAVA level". Inclusion criteria focused on studies involving NAVA, published in peer-reviewed journals and available in English.

Research indicates that NAVA markedly enhances the synchronization and coordination between patients and ventilators, fostering a more harmonious interaction that can improve overall respiratory outcomes. Additionally, NAVA has the potential to mitigate the risks associated with both excessive and insufficient assistance of ventilation to some degree, thereby lessening the reliance on sedative and antalgic medications, which can have various side effects, and aiding in the successful liberating processes from mechanical ventilation (MV). The level of NAVA, referred to as NAVAL, is pivotal when employing this mode for effective disease management, as it guarantees both the efficacy and safety of the treatment provided to patients.

E_Adi has demonstrated distinct advantages in various clinical applications, showcasing its versatility and importance in respiratory care. However, it is essential to acknowledge that certain inherent limitations of NAVA in clinical practice exist, implying that clinicians should adopt a careful and judicious approach when implementing NAVA to ensure optimal patient outcomes.