Utilization of Neurally Adjusted Ventilatory Assist (NAVA) Mode in Infants and Children Undergoing Congenital Heart Surgery: A Retrospective Review
We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. The ventilatory and gas exchange parameters for the 24 h pre- and post-transition to NAVA were compared. Additional parameters assessed included pain scores and sedation requirements. Eighty-one patients met inclusion criteria with a median age of 21 days (interquartile range 13 days–2 months). The majority of patients enrolled (75.3%) had complex congenital heart disease with high surgical severity scores. The transition to NAVA was tolerated by all patients without complications. The mean peak inspiratory pressure (PIP) was 1.8 cm H2O lower (p < 0.001) and mean airway pressure (Paw) was 0.5 cm H2O lower (p = 0.009) on NAVA compared to conventional modes of mechanical ventilation. There was no significant difference in patients’ respiratory rate, tidal volume, arterial pH, pCO2, and lactate levels between the two modes of ventilation. There was a decreased sedation requirement during the time of NAVA ventilation. Comfort scores did not differ significantly with ventilator mode change. We concluded that NAVA is safe and well-tolerated mode of mechanical ventilation for our cohort of patients after congenital heart surgery. Compared to conventional ventilation there was a statistically significant decrease in PIP and Paw on NAVA.
KeywordsNeurally adjusted ventilatory assist Congenital heart surgery Mechanical ventilation Diaphragm activity Pediatrics
We would like to thank Joan Hoffman, MD, Cheryl Lefaiver, PhD, RN, and Traci Wolfe, RT, for their careful manuscript review and Bonnie Hughes, RN, BSN, CCRC for her assistance with study regulatory documents.
BH helped design the study, completed data collection, assisted with result interpretation, drafted original manuscript and coordinated manuscript revisions. AM helped with data collection and reviewed manuscript. YL assisted with statistical analysis, reviewed and revised the manuscript. AVB conceptualized and designed the study, supervised data collection, provided content expertise, interpreted results, and contributed to the manuscript creation and review.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest.
All procedures were performed in accordance with the ethical standards of Advocate Health Care’s Institutional Review Board and with the 1964 Helskinki Declaration and its later amendments or comparable ethical standards.
As per the Institutional Review Board, informed consent was waived due to the retrospective study design.