Clinical Application of Neurally Adjusted Ventilatory Assist in Neonates with Respiratory Distress: A Systematic Review

Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that coordinates the mechanical ventilator and the patient via electrical impulses of the diaphragm. Using these impulses as neural triggers, the patient’s respiration synchronizes with the ventilator. Ventilation with NAVA has successfully been performed in adults with various lung diseases but the application of NAVA in neonates is a novel issue. The aim of this review study was to emphasize the NAVA as a new way of neonatal ventilatory support and the importance of ventilator-neonate synchrony in neonatal intensive care units.
Study Selection: Several studies have evaluated NAVA in the neonatal period but we described here the cardinal studies. Therefore, we included studies performing NAVA in the neonatal and pediatric population. The review of 10 studies showed that asynchrony was less frequent when using NAVA than when using the pneumatic modes of ventilation. Most of the studies observed a reduction in peak inspiratory pressure (PIP) and FIO2 with NAVA. A reduction in mean airway pressure and work of breathing and an improvement in gas exchange were also observed in some of the studies. We concluded that according to recent studies, the NAVA should be administered in neonates for better synchronization with ventilator and improving the gas exchange and outcomes.