Neurally Adjusted Ventilatory Assist NAVA

66 75 915 Rev. 01

Θεόδωρος Βασιλακόπουλος

Esophagus

NAVA

Edi Catheter Edi Cable

PC Card

Edi Module

Edi

VT

Health Disease

Neuroventilatory coupling

μV μV μV

ml ml ml

66 75 915 Rev. 01

NAVA

Edi Catheter

NAVA accessories

Edi Cable

PC Card

Edi Module

Edi Catheter

Fr (French) = circumference of the catheter in mm

1. Connection to Edi cable 2. Nutrition feed 3. Evacuation (only 12 and 16 Fr) 4. Reference electrode 5. Electrodes (9) 6. Holes for nutrition/evacuation 7. Inter Electrode Distance (IED) 8. Lumen for electrodes 9. Sump lumen (only 12 and 16 Fr) 10. Feeding lumen 11. Barium strip for X-ray identification 12. Coating for easier insertion and better

electrical conductivity (indicated in the picture with light blue)

13. Scale in centimeters from the tip

Edi Catheters Inter Electrode Distance (IED)

Fr (French) = circumference of the catheter in mm

Edi Catheters Package

Each Edi Catheter is sterile and packed individually

Package can be used for dipping the Edi Catheter in water

Instruction for insertion and positioning of the Edi Catheter come with the package of each Edi Catheter

Delivered in boxes of 5

Edi Module

– One slot Plug-In module – Interchangeable – 50 Hz and 60 Hz – Filtering to retrieve the Edi and ECG signals – Processing the Edi signal – Edi Module cable + Edi Test plug for function check

Edi Cable

Edi Module

Function test

Edi Catheter positioning procedure The NEX-measure

Insertion distance Y for nasal insertion

NEX cm x 0.9 + 2.5 = Y cm6 Fr 49 cm

NEX cm x 0.9 + 3.5 = Y cm6 Fr 50 cm

NEX cm x 0.9 + 8 = Y cm8 Fr 100 cm

NEX cm x 0.9 + 18 = Y cm8 Fr 125 cm

NEX cm x 0.9 + 15 = Y cm12 Fr

NEX cm x 0.9 + 18 = Y cm16 Fr

Calculation of YFr/cm

Insertion distance Y for nasal insertion

NEX cm x 0.9 + 2.5 = Y cm6 Fr 49 cm

NEX cm x 0.9 + 3.5 = Y cm6 Fr 50 cm

NEX cm x 0.9 + 8 = Y cm8 Fr 100 cm

NEX cm x 0.9 + 18 = Y cm8 Fr 125 cm

NEX cm x 0.9 + 15 = Y cm12 Fr

NEX cm x 0.9 + 18 = Y cm16 Fr

Calculation of YFr/cm

Edi Catheter positioning procedure Nasal insertion

Insertion distance Y for oral insertion

NEX cm x 0.8 + 2.5 = Y cm6 Fr 49 cm

NEX cm x 0.8 + 3.5 = Y cm6 Fr 50 cm

NEX cm x 0.8 + 8 = Y cm8 Fr 100 cm

NEX cm x 0.8 + 18 = Y cm8 Fr 125 cm

NEX cm x 0.8 + 15 = Y cm12 Fr

NEX cm x 0.8 + 18 = Y cm16 Fr

Calculation of YFr/cm

Insertion distance Y for oral insertion

NEX cm x 0.8 + 2.5 = Y cm6 Fr 49 cm

NEX cm x 0.8 + 3.5 = Y cm6 Fr 50 cm

NEX cm x 0.8 + 8 = Y cm8 Fr 100 cm

NEX cm x 0.8 + 18 = Y cm8 Fr 125 cm

NEX cm x 0.8 + 15 = Y cm12 Fr

NEX cm x 0.8 + 18 = Y cm16 Fr

Calculation of YFr/cm

Edi Catheter positioning procedure Oral insertion

Edi Catheter positioning procedure Insert the Edi Catheter

Edi Catheter positioning procedure Connect the cable

Edi Catheter positioning procedure Neural access

Edi Catheter positioning procedure Edi Catheter positioning window

Four ECG waveforms for Edi catheter position Edi waveform Scale and sweep speed

settings Freeze function Numerical values of Edi

peak and Edi min

Edi Catheter positioning procedure Position and Edi signal

Edi Catheter positioning procedure Position and Edi signal

Edi Catheter too far down

Edi Catheter positioning procedure Position and Edi signal

Edi Catheter too far up

Select ventilation mode

Set NAVA ventilation mode

P (cm H2O)

Edi (μV)

20

10

10

20

1

0.5

24

NAVA level

Ppeak (Pest) in NAVA = = NAVA Level x (Edi peak – Edi min) + PEEP

Edi trigger level

Edi cycling off

Cycling off 70% Edi max

expiration

NAVA preview

Estimated Ppeak (Pest) in NAVA =

= NAVA Level x (Edi peak – Edi min) + PEEP

Additional settings

NAVA

NAVA (PS)

Backup NAVA (PC)

Running in NAVA mode

NAVA Backup function

NAVA Backup NAVA (PC)

Low Edi signal

Hyperventilation

Sedation

Neural disorder

Muscle relaxants

Brander L et al. Chest 2009;135:695-703

Group data for the interaction among mean inspiratory Paw including PEEP, Pes, and Ptp during the NAVA level titration

Brander L et al. Chest 2009;135:695-703

Sigh, followed by apnea

Restrictive and obstructive lung dsease

Tracheostomy / Mechanical ventilation > 20 days

NAVA = Real time proportional ventilation

Patient - ventilator asynchrony during assisted mechanical ventilation

- 25% of patients exhibit a high incidence of (inspiratory) asynchrony >10% during assisted ventilation. - Such a high incidence is associated with a prolonged duration of mechanical ventilation. - Patients with frequent ineffective triggering may receive excessive levels of ventilatory support.

Thille et al Patient-Ventilator Asynchrony during assisted Mechanical Ventilation; Intensive Care Med; 2006; 32:1515 - 1522

Colombo D.et al.; Physiologic response to varying levels of Pressure Support and Neurally Adjus- ted Ventilatory Assist in patients with acute respiratory failure; Intensive Care Med 2008;34:2010-8

Colombo D.et al.; Physiologic response to varying levels of Pressure Support and Neurally Adjus- ted Ventilatory Assist in patients with acute respiratory failure; Intensive Care Med 2008;34:2010-8

Colombo D.et al.; Physiologic response to varying levels of Pressure Support and Neurally Adjus- ted Ventilatory Assist in patients with acute respiratory failure; Intensive Care Med 2008;34:2010-8

- PS had an Asynchrony Index > 10% in 36% of patients with NAVA 0% - NAVA limited the risk for over-assist compared to PS

- NAVA clearly improved patient-ventilator interaction

Pressure Support compared to NAVA

Edi Monitoring

NAVA : Conclusions - Better synchrony compared to controlled and assist ventilation modes - Proportionality to patients demands - Unloading the diaphragm by increasing the NAVA level - Enhance respiratory monitoring