UK NAVA - therapies
Intervention-NAVA technology
Identifying Patients
Therapies teams, including Speech & Language; Neurophysiotherapy, Respiratory Physiotherapy are critically important to the design and delivery of the UK NAVA trial. They will help us to identify all patients who are eligible for the UK NAVA Trial.
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The main inclusion criteria for UK NAVA is ventilated patients who are expected to be ventilated for more than 48 hours and who are either showing evidence of breathing spontaneously and/or who are ready for a sedation hold. The patients cannot have been in a completely spontaneous mode such as pressure support or NAVA for > 24 hours pre-randomisation.
Using NAVA technology optimally
Speech & Language therapists and Physiotherapists involved in providing critical care interventions will be vital in ensuring NAVA monitoring and NAVA mode are used optimally. This will include integrating the use of NAVA mode into any ventilatory weaning plan but also using NAVA monitoring to look at the effect of cuff deflation, speaking valves, and mobilisation on neural drive. Further, therapies teams can ensure that neural drive monitoring continues post extubation and ensure that ventilatory and airway weaning are considered together.
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Therapy teams can utilise trend views of neural drive to help tailor rehabilitation.
Monitoring the Edi - benefits of being able to see patient neural drive
Edi (Neural drive) Magnitude | Effect of Critical Care Interventions on Edi
Monitoring Asynchrony with Edi monitoring | Edi after extubation
The Edi signal can be made to overlay over the standard pressure support breaths. It can monitor the level of neural drive the patient has ( level of 'dyspnoea') and tell you if the patient's respiratory drive is out-of-step with the support breaths- asyncrony) with the delivered pressure support breaths. Note: when you are using the NAVA catheter to monitor the patient like this, nothing new is being done to the patient - the patient is NOT yet in NAVA mode. There are multiple forms of asyncrony.
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You will get information that you would not otherwise have known. For example, you could present this in shift handover.
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In UK NAVA we want the clinical team of the patient randomised to NAVA intervention to consider putting the patient in the NAVA pressure support mode at least daily. The presence of asyncrony may prompt this decision.
Ventilating and weaning with NAVA mode
NAVA mode follows the Edi and allows the patient to select tidal volume and respiratory pattern.
Patient with tracheostomy and speaking valve-he found it more comfortable to use the speaking valve in NAVA than when in pressure support. Despite a spinal cord injury at C5-6 he was generally significantly more comfortable in NAVA than pressure support.
