Ventilator controlled by brain signals helps infants in critical
condition
6 May 2009
Patient case reports from several hospitals show that a revolutionary
technique for assisted breathing by mechanical ventilation called NAVA
can improve the interaction between a child and the ventilator. The NAVA
approach to mechanical ventilation is based on the patient’s neural
respiratory output, and it is designed for use on adults as well as
children.
The assisted breathing is driven by the patient’s brain and improves
synchrony between the child and ventilator. Children in intensive care
sometimes require a ventilator for breathing assistance and in some
cases for survival. A cutting edge technology called NAVA (neurally
adjusted ventilatory assist), developed by MAQUET Critical Care, allows
the patient’s own respiratory signals from the brain to the diaphragm to
drive the ventilator, making it an effective instrument for recovery.
Professor Said Hachimi-Idrissi, of the University Hospital of
Brussels, describes a particularly complex case involving a
three-year-old with weak and rigid lungs, who had oxygenation problems
as well as emphysema, where a lung transplantation was even considered:
“She was a nightmare for all of the ICU staff, but we put her on NAVA,
against all concepts of conventional ventilation, and she did well. Her
neural response led to the pressures being reduced, and her oxygenation
levels stabilized, and we were finally able to extubate her after one
week on NAVA. We were all amazed.”
With conventional mechanical ventilation, there is frequently a
battle between the ventilator and the child. Some children fight the
ventilator even though they cannot breathe properly on their own, often
requiring deep sedation levels. With NAVA, the assistance is delivered
as soon as the patient requires it. Furthermore, NAVA improves the
synchrony between the patient and the ventilator.
Dr Zhu Limin, Department of Cardiovascular Thoracic Surgery,
Children’s Medical Center in Shanghai, treated a two-month-old baby
suffering from transposition of the great arteries and severe extubation
difficulties with NAVA following a second surgery: “He was spontaneously
breathing with NAVA for about three days, followed by successful
extubation. One week later, we were able to finally discharge him.”
When children are critically ill, it is sometimes hard to make the
ventilator work in synchrony with the patients’ weak attempts for
breaths. NAVA, which is available on MAQUET Critical Care’s SERVO-i
ventilator, facilitates patient comfort by providing the required amount
of assistance at the moment the patient needs it.
“These case reports are testimonials to why NAVA is becoming an
important tool in Critical Care Units in hospitals around the world,”
said Dan Rydberg, Managing Director of MAQUET Critical Care in Solna,
Sweden. “The greatest strength is of course that the patient’s own
breathing is facilitated and that he or she has the potential to be
taken off ventilation much earlier. A win-win situation for all parties
involved.”
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