Non invasive ventilation with neurally adjusted ventilatory assist in the pediatric intensive care unit

Non invasive ventilation (NIV) is a therapeutic modality frequently used in pediatric intensive care units in order to avoid intubation. However, about 25% of children fail and require invasive ventilation. Poor patient-ventilator synchrony is one of the reasons why patients fail to respond to NIV. The new mode of ventilation NAVA (neurally adjusted ventilatory assist) allows better patient-ventilator synchrony which could potentially improve the efficiency of NIV. The objectives of this paper are to review the available data, and propose practice guidelines on the use of NIV-NAVA in critically ill children, based on published evidence and on our clinical experience. The available studies evaluate the physiological aspects of the NAVA over short periods of observation. All studies confirm improved patient-ventilator synchrony. Given that clinical experience suggests that certain patients might benefit from improved support, further studies are required to evaluate the clinical impact of NIV-NAVA on comfort, failure rates, and length of ventilatory support in critically ill children.