Intensive Care Medicine

, Volume 42, Issue 11, pp 1723–1732 | Cite as

Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial

  • A. DemouleEmail author
  • M. Clavel
  • C. Rolland-Debord
  • S. Perbet
  • N. Terzi
  • A. Kouatchet
  • F. Wallet
  • H. Roze
  • F. Vargas
  • C. Guerin
  • J. Dellamonica
  • S. Jaber
  • L. Brochard
  • T. Similowski



Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that tailors the level of assistance delivered by the ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation.


A multicentre randomized controlled trial of 128 intubated adults recovering from acute respiratory failure was conducted in 11 intensive care units. Patients were randomly assigned to NAVA or PSV. The primary outcome was the probability of remaining in a partial ventilatory mode (either NAVA or PSV) throughout the first 48 h without any return to assist-control ventilation. Secondary outcomes included asynchrony index, ventilator-free days and mortality.


In the NAVA and PSV groups respectively, the proportion of patients remaining in partial ventilatory mode throughout the first 48 h was 67.2 vs. 63.3 % (P = 0.66), the asynchrony index was 14.7 vs. 26.7 % (P < 0.001), the ventilator-free days at day 7 were 1.0 day [1.0–4.0] vs. 0.0 days [0.0–1.0] (P < 0.01), the ventilator-free days at day 28 were 21 days [4–25] vs. 17 days [0–23] (P = 0.12), the day-28 mortality rate was 15.0 vs. 22.7 % (P = 0.21) and the rate of use of post-extubation noninvasive mechanical ventilation was 43.5 vs. 66.6 % (P < 0.01).


NAVA is safe and feasible over a prolonged period of time but does not increase the probability of remaining in a partial ventilatory mode. However, NAVA decreases patient–ventilator asynchrony and is associated with less frequent application of post-extubation noninvasive mechanical ventilation.

Trial Registration. Identifier: NCT02018666.


Mechanical ventilation Weaning Neurally adjusted ventilatory assist Patient–ventilator asynchrony Ventilator-free days Noninvasive ventilation 


Compliance with ethical standards

Conflicts of interest

This study is an investigator-initiated trial that received financial support from Maquet. Maquet had no access to the data and was not involved in the analysis or writing of the manuscript. Alexandre Demoule has signed research contracts with Covidien, Maquet and Philips; he has also received personal fees from Covidien, Maquet and MSD. Samir Jaber has received personal fees from Dräger, Fisher and Paykel, Hamilton, and Maquet. Laurent Brochard declares research contracts with Covidien, Dräger, General Electric, as well as equipment provided by Maquet and by Philips for research protocols. Thomas Similowski belongs to the board of a research association that has received, over the past 10 years, unrestricted research grants from Maquet, Hamilton, Covidien and Philips; he is the head of a research unit (UMRS 1158) that has signed research contracts with Air Liquide Medical Systems, France; he declares no personal conflict of interest with mechanical ventilation firms; he is listed as inventor or co-inventor on several patents, granted or pending, describing a brain–ventilator interface. Marc Clavel, Camille Rolland-Debord, Sebastien Perbet, Nicolas Terzi, Achille Kouatchet, Florent Wallet, Hadrien Roze, Frederic Vargas, Claude Guerin and Jean Dellamonica have no conflict of interest related to this work.

Supplementary material

134_2016_4447_MOESM1_ESM.docx (41 kb)
Supplementary material 1 (DOCX 41 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • A. Demoule
    • 1
    • 2
    Email author
  • M. Clavel
    • 3
  • C. Rolland-Debord
    • 1
    • 2
  • S. Perbet
    • 4
    • 5
  • N. Terzi
    • 6
    • 7
  • A. Kouatchet
    • 8
  • F. Wallet
    • 9
    • 10
  • H. Roze
    • 11
  • F. Vargas
    • 12
  • C. Guerin
    • 13
  • J. Dellamonica
    • 14
    • 15
  • S. Jaber
    • 16
    • 17
  • L. Brochard
    • 18
    • 19
  • T. Similowski
    • 1
    • 2
  1. 1.Service de Pneumologie et Réanimation Médicale (Département “R3S”), Groupe Hospitalier Pitié-Salpêtrière Charles FoixAP-HPParisFrance
  2. 2.Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueParisFrance
  3. 3.Réanimation PolyvalenteHôpital DupuytrenLimogesFrance
  4. 4.Réanimation Médico-ChirurgicaleCHU de Clermont-FerrandClermont-FerrandFrance
  5. 5.R2D2 EA-7281, Université d’AuvergneClermont-FerrandFrance
  6. 6.INSERM U1042, Université Grenoble-Alpes, HP2GrenobleFrance
  7. 7.Service de Réanimation MédicaleCHU Grenoble AlpesGrenobleFrance
  8. 8.Service de Réanimation Médicale et Médecine HyperbareCHU d’Angers, AngersAngersFrance
  9. 9.Réanimation Médicale et ChirurgicaleCentre Hospitalier Lyon-SudLyonFrance
  10. 10.Laboratoire des Pathogènes Emergents, Centre International de Recherche en InfectiologieInserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1LyonFrance
  11. 11.Anesthésie et RéanimationCHU de BordeauxPessacFrance
  12. 12.Réanimation MédicaleHôpital Pellegrin-TripodeBordeauxFrance
  13. 13.Réanimation MédicaleHôpital de la Croix RousseLyonFrance
  14. 14.Réanimation Médicale, Hôpital de l’ArchetCentre Hospitalier Universitaire de NiceNiceFrance
  15. 15.INSERM 1065 Team 3 C3 MNiceFrance
  16. 16.Anesthésie et RéanimationHôpital Saint-EloiMontpellierFrance
  17. 17.Montpellier School of MedicineUniversity of Montpellier, INSERM U1046, CNRS UMR 9214MontpellierFrance
  18. 18.Keenan Research Centre and Li Ka Shing InstituteSaint-Michael’s HospitalTorontoCanada
  19. 19.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada

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