NAVA

Q: In neurally adjusted ventilatory assist ventilation (NAVA), electrical discharge from the diaphragm (EAdi) is detected by a catheter embedded in? 

A) Central Venous Catheter 
B) Naso-gastric tube 
C) Ventilator circuit 
D)Endo-tracheal tube (ETT) 
E) Cutaneous pacer


Answer: B

Neurally adjusted ventilatory assist ventilation (NAVA) is still an investigational mode of ventilation. It's working depends on the diaphragmatic excitation, technically known as 'electrical discharge from the diaphragm' (EAdi). The deflection above the set threshold is detected via a catheter embedded in a nasogastric tube to deliver a mechanical breath. 

NAVA is best utilized when patient-ventilator asynchrony becomes detrimental and cannot be fixed via more conventional modes of ventilation. The biggest hurdle in the use of NAVA is the requirement of spontaneously breathing patient. It cannot be used in a patient with decrease respiratory drive as in deep sedation.

#ventilator
#pulmonary


References:


1. Piquilloud L, Vignaux L, Bialais E, et al. Neurally adjusted ventilatory assist improves patient-ventilator interaction. Intensive Care Med 2011; 37:263. 

2. Schmidt M, Kindler F, Cecchini J, et al. Neurally adjusted ventilatory assist and proportional assist ventilation both improve patient-ventilator interaction. Crit Care 2015; 19:56. 

3. Demoule A, Clavel M, Rolland-Debord C, et al. Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial. Intensive Care Med 2016; 42:1723.