Neurally Adjusted Ventilatory Assist

**NICU Guy, BSN, RN** · Mar 26, 2018

We use it all the time. I like the fact that once they can be extubated, we can put a nasal prongs/mask on them and continue to use it NIV NAVA mode.

adventure_rn, MSN, NP · Apr 2, 2018

We use it, both invasive (still intubated) and non-invasive (with CPAP headgear). It's great that kids can be extubated earlier, but it doesn't always work very well in practice. The system senses diaphragmatic innervation with an EDI catheter, which is taped to the mouth like an OG tube. The EDI catheter is prone to sliding around (due to drool or the baby tonguing it out), and when it bows in and out it doesn't work very well. We can see issues with interference when using it on the micros--they're so tiny that it's hard to keep the EDI catheter in precisely the right position. The system also doesn't work if the baby has too great of an air leak around the ETT or CPAP equipment, which is tricky when you've got squirmy kids who can't be sedated and wiggle out of their headgear. It's fairly common for kids to start autocycling at 90 breaths per minute, which I'm sure is not good for them (both from an acid-base perspective, and from a barotrauma perspective). We usually joke that when a baby is on NAVA, we'll be listening to the vent alarm all night. It has its advantages, but it definitely has some drawbacks.

One of the biggest barriers I've seen to practice is MDs, NPs, and RTs not having experience using NAVA. The set-up is fascinating, but not very intuitive. I worked at one facility where we had the technology but almost never used it since the providers didn't feel comfortable ordering it. At my current facility, the neonatology medical director loves NAVA and made it standard practice; now we use it here all of the time.

meanmaryjean, DNP, RN · Apr 2, 2018

Had a home care kiddo who was a micro preemie and failed multiple extubations and weans. NAVA worked for him, and he is now decannulated, off the vent and rides the bus to school every day.