Clinical outcomes in patients undergoing invasive mechanical ventilation using NAVA and other ventilation modes - A systematic review and meta-analysis

Abstract

Purpose: Neurally adjusted ventilatory assist mode (NAVA) benefit in mechanical ventilation (MV) patients with regard to clinically outcomes is still uncertain. Recent randomized clinical trials (RCTs) have addressed this issue, making it important to assess the real impact of NAVA in relation to these outcomes.

Materials and methods: We performed a systematic review and meta-analysis of RCTs comparing NAVA ventilation mode versus the standard ventilation mode in critically ill adult patients admitted to the ICU with invasive MV. The main outcome was 28-days ventilatory free-days (VFD). Secondary outcomes were weaning failure, mortality, ICU and hospital length of stay and need for tracheostomy.

Results: We included 5 RCTs (643 patients). The patients in the NAVA group had increased VFDs compared to the control group: mean difference (MD) 3.42 (95% CI 1.21 to 5.62, I² = 0%). NAVA and control groups did not differ in ICU mortality [OR 0.58 (95% CI 0.33 to 1.03), I2 = 41%]. NAVA mode was associated with a reduced incidence of weaning failure [OR 0.51 (95% CI 0.29 to 0.88), I² = 0%]. NAVA and control groups did not differ in the number of MV days: MD -1.9 days (95% CI -4.2 to 0.3, I² = 0%).

Conclusions: NAVA mode has a modest impact on MV-free days and weaning success, with no association with improvements in other relevant clinical outcomes.

Keywords: Mechanical ventilation; NAVA; Neurally adjusted ventilatory assist; PCV; PSV; Weaning.