A prospective crossover study of neurally adjusted ventilatory assistance (NAVA) versus conventional ventilation in a pediatric ICU

Abstract Background Neurally adjusted ventilatory assistance (NAVA) is a new mode of ventilation that uses the electrical activity of the diaphragm (Edi) as a trigger to the patient’s breath, and this causes better patient–ventilator synchrony. The study aims to compare asynchrony during NAVA ventilation and conventional ventilation. Methods This prospective crossover study included 15 patients needing mechanical ventilation who were admitted to Pediatric Intensive Care Unit in Cairo University Children’s Hospital during the period from 2021 to 2024. Each patient was ventilated alternately with NAVA and conventional ventilation, switching modes every 6 h until weaning and extubation. The final 15 min of each 6-h interval were recorded and analyzed for asynchronous events. Results The asynchrony index (AI) was much lower during NAVA ventilation with a mean value of 3.48% (0%–15%), while during conventional ventilation mean AI was 11.73% (1.23%–31%), with a P value of 0.009 (mean difference: − 8.24%, 95% CI: − 13.89 to − 2.59). The main asynchronous event during NAVA was double triggering while auto-triggering was the main asynchronous event during conventional ventilation. Conclusion Neurally adjusted ventilatory assist was found to improve patient–ventilator interaction and is associated with a lower asynchrony index compared to conventional ventilation; however, the small sample size requires cautious interpretation and further validation in larger cohorts.