The following is a summary of “Clinical outcomes in patients undergoing invasive mechanical ventilation using NAVA and other ventilation modes – A systematic review and meta-analysis,” published in the March 2023 issue of the Critical Care by Pinto, et al.
Concerns remain about the clinical efficacy of the neurally adjusted ventilatory assist mode (NAVA) for patients on mechanical ventilation (MV). It is crucial to evaluate the true impact of NAVA regarding these outcomes as they have recently been the subject of randomized clinical trials (RCTs). Therefore, researchers conducted a meta-analysis of randomized controlled trials to determine whether or not critically sick adults admitted to the ICU with invasive MV fared better when ventilated using the NAVA mode compared to the normal mode.
Ventilatory-free days (VFD) at 28 days were the primary measure of success. Weaning failure, mortality, length of intensive care unit and hospital stay, and tracheostomy necessity were secondary outcomes. The analysis incorporated data from 5 randomized controlled trials (totaling 643). Patients in the NAVA group showed higher VFDs than those in the control group (MD 3.42, 95% CI 1.21 to 5.62, I2 = 0%).
Mortality in the intensive care unit (ICU) did not differ between the NAVA and control groups [OR 0.58 (95% CI 0.33 to 1.03), I2 = 41%]. There was a trend toward fewer weaning failures when using NAVA mode [OR 0.51 (95% CI 0.29 to 0.88), I2 = 0%]. MD -1.9 days (95% CI -4.2 to 0.3, I2 = 0%) between NAVA and control groups showed no significant difference in MV days. There is no correlation between NAVA mode and improvements in other important clinical outcomes. However, it does have a small effect on MV-free days and weaning success.
Source: sciencedirect.com/science/article/abs/pii/S0883944123000369