Intensive Care Medicine

, Volume 38, Issue 10, pp 1624–1631 | Cite as

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

  • Lise PiquilloudEmail author
  • Didier Tassaux
  • Emilie Bialais
  • Bernard Lambermont
  • Thierry Sottiaux
  • Jean Roeseler
  • Pierre-François Laterre
  • Philippe Jolliet
  • Jean-Pierre Revelly



To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient–ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask.


In this prospective interventional study we compared patient–ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d), the patient’s neural inspiratory time (T in), ventilator pressurization duration (T iv), inspiratory time in excess (T iex), number of asynchrony events per minute and asynchrony index (AI) were determined.


The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31–53 ms) versus 181 ms (122–208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5–3.1 events/min) versus 4.4 events/min (0.9–12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5–10.5 %) versus 15.8 % (5.5–49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO2 and PaCO2 were not different between ventilatory modes.


Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.


Patient-ventilator interaction Patient-ventilator synchrony Noninvasive Ventilation Pressure support Neurally adjusted ventilatory assist 



The authors wish to thank the Swiss Society of Intensive Care Medicine research fund for its financial support and Maquet Critical Care for having provided NAVA nasogastric tubes free of charge.

Supplementary material

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Supplementary material 1 (DOCX 1146 kb)


  1. 1.
    Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355PubMedCrossRefGoogle Scholar
  2. 2.
    Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755PubMedCrossRefGoogle Scholar
  3. 3.
    Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A (2006) Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 173:164–170PubMedCrossRefGoogle Scholar
  4. 4.
    Yamada Y, Du HL (2000) Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation: a mathematical approach. J Appl Physiol 88:2143–2150PubMedGoogle Scholar
  5. 5.
    Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522PubMedCrossRefGoogle Scholar
  6. 6.
    Vignaux L, Vargas F, Roeseler J, Tassaux D, Thille AW, Kossowsky MP, Brochard L, Jolliet P (2009) Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med 35:840–846PubMedCrossRefGoogle Scholar
  7. 7.
    Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880PubMedGoogle Scholar
  8. 8.
    Vignaux L, Tassaux D, Jolliet P (2007) Performance of noninvasive ventilation modes on ICU ventilators during pressure support: a bench model study. Intensive Care Med 33:1444–1451PubMedCrossRefGoogle Scholar
  9. 9.
    Vignaux L, Tassaux D, Carteaux G, Roeseler J, Piquilloud L, Brochard L, Jolliet P (2010) Performance of noninvasive ventilation algorithms on ICU ventilators during pressure support: a clinical study. Intensive Care Med 36:2053–2059PubMedCrossRefGoogle Scholar
  10. 10.
    Carteaux G, Lyazidi A, Cordoba-Izquierdo A, Vignaux L, Jolliet P, Thille AW, Richard JC, Brochard L (2012) Patient-ventilator asynchrony during noninvasive ventilation: a bench and clinical study. Chest. doi: 10.1378/chest.11-2279
  11. 11.
    Moerer O, Beck J, Brander L, Costa R, Quintel M, Slutsky AS, Brunet F, Sinderby C (2008) Subject-ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Med 34:1615–1623PubMedCrossRefGoogle Scholar
  12. 12.
    Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433–1436PubMedCrossRefGoogle Scholar
  13. 13.
    Piquilloud L, Vignaux L, Bialais E, Roeseler J, Sottiaux T, Laterre PF, Jolliet P, Tassaux D (2011) Neurally adjusted ventilatory assist improves patient-ventilator interaction. Intensive Care Med 37:263–271PubMedCrossRefGoogle Scholar
  14. 14.
    Spahija J, de Marchie M, Albert M, Bellemare P, Delisle S, Beck J, Sinderby C (2010) Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 38:518–526PubMedCrossRefGoogle Scholar
  15. 15.
    Colombo D, Cammarota G, Bergamaschi V, De Lucia M, Corte FD, Navalesi P (2008) Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 34:2010–2018PubMedCrossRefGoogle Scholar
  16. 16.
    Terzi N, Pelieu I, Guittet L, Ramakers M, Seguin A, Daubin C, Charbonneau P, du Cheyron D, Lofaso F (2010) Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: physiological evaluation. Crit Care Med 38:1830–1837PubMedCrossRefGoogle Scholar
  17. 17.
    Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444PubMedCrossRefGoogle Scholar
  18. 18.
    Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822PubMedCrossRefGoogle Scholar
  19. 19.
    Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, Sinderby C (2001) Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 164:419–424PubMedGoogle Scholar
  20. 20.
    Barwing J, Ambold M, Linden N, Quintel M, Moerer O (2009) Evaluation of the catheter positioning for neurally adjusted ventilatory assist. Intensive Care Med 35:1809–1814PubMedCrossRefGoogle Scholar
  21. 21.
    Beck J, Campoccia F, Allo JC, Brander L, Brunet F, Slutsky AS, Sinderby C (2007) Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits. Pediatr Res 61:289–294PubMedCrossRefGoogle Scholar
  22. 22.
    Beck J, Reilly M, Grasselli G, Mirabella L, Slutsky AS, Dunn MS, Sinderby C (2009) Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants. Pediatr Res 65:663–668PubMedCrossRefGoogle Scholar
  23. 23.
    Cammarota G, Olivieri C, Costa R, Vaschetto R, Colombo D, Turucz E, Longhini F, Della Corte F, Conti G, Navalesi P (2011) Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation. Intensive Care Med 37:1943–1950PubMedCrossRefGoogle Scholar
  24. 24.
    Thille AW, Cabello B, Galia F, Lyazidi A, Brochard L (2008) Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation. Intensive Care Med 34:1477–1486PubMedCrossRefGoogle Scholar
  25. 25.
    Tassaux D, Gainnier M, Battisti A, Jolliet P (2005) Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med 172:1283–1289PubMedCrossRefGoogle Scholar
  26. 26.
    Prinianakis G, Delmastro M, Carlucci A, Ceriana P, Nava S (2004) Effect of varying the pressurisation rate during noninvasive pressure support ventilation. Eur Respir J 23:314–320PubMedCrossRefGoogle Scholar
  27. 27.
    Viale JP, Duperret S, Mahul P, Delafosse B, Delpuech C, Weismann D, Annat G (1998) Time course evolution of ventilatory responses to inspiratory unloading in patients. Am J Respir Crit Care Med 157:428–434PubMedGoogle Scholar
  28. 28.
    Whitelaw WA, Derenne JP, Milic-Emili J (1975) Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol 23:181–199PubMedCrossRefGoogle Scholar
  29. 29.
    Kondili E, Prinianakis G, Georgopoulos D (2003) Patient-ventilator interaction. Br J Anaesth 91:106–119PubMedCrossRefGoogle Scholar
  30. 30.
    Nava S, Bruschi C, Fracchia C, Braschi A, Rubini F (1997) Patient-ventilator interaction and inspiratory effort during pressure support ventilation in patients with different pathologies. Eur Respir J 10:177–183PubMedCrossRefGoogle Scholar
  31. 31.
    Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M (1997) Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 112:1592–1599PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Lise Piquilloud
    • 1
    Email author
  • Didier Tassaux
    • 2
  • Emilie Bialais
    • 3
  • Bernard Lambermont
    • 4
  • Thierry Sottiaux
    • 5
  • Jean Roeseler
    • 3
  • Pierre-François Laterre
    • 3
  • Philippe Jolliet
    • 1
  • Jean-Pierre Revelly
    • 1
  1. 1.Intensive Care and Burn UnitUniversity Hospital of Lausanne (CHUV)LausanneSwitzerland
  2. 2.Intensive Care UnitUniversity Hospital of Geneva (HUG)GenevaSwitzerland
  3. 3.Intensive Care UnitUniversity Hospital St-LucBrusselsBelgium
  4. 4.Medical Intensive Care UnitCHU LiegeLiegeBelgium
  5. 5.Intensive Care UnitClinique Notre Dame de GrâceGosseliesBelgium

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