Dr. Guillaume Emeriaud is a Professor of Pediatrics and pediatric intensivist at Sainte Justine Hospital in Montreal, with expertise in children’s ventilatory support. He discusses Neurally Adjusted Ventilatory Assist (NAVA) and its groundbreaking applications in pediatric critical care. The conversation covers its advantages over traditional ventilation methods, the significance of monitoring diaphragmatic electrical activity, and the complexities of ensuring optimal patient support. Insights into NAVA's cost-effectiveness and catheter insertion techniques add to the rich discussion.
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Emeriaud's NAVA Journey
Dr. Guillaume Emeriaud shared his 25-year research journey on diaphragmatic electrical activity (EDI) monitoring before NAVA was commercially available.
He witnessed the evolution from homemade setups to clinical bedside technology, emphasizing his role in accompanying NAVA's development.
insights INSIGHT
NAVA's Physiologic Basis
NAVA uses a nasogastric tube with microelectrodes to measure diaphragmatic electrical activity to trigger and proportionally support breaths.
This allows synchronized and proportional ventilatory assistance tailored to the patient's breathing effort.
insights INSIGHT
EAdi: Monitoring True Drive
EAdi monitoring reveals the patient's actual respiratory effort and drive, even in intubated patients where spontaneous activity may be underestimated.
This monitoring can be used independently for assessing patient activity, not just for NAVA ventilation.
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Guillaume Emeriaud MD PhD is a Professor of Pediatrics at the University of Montreal and pediatric intensivist at Sainte Justine Hospital in Montreal, Canada. He is a physician scientist with a particular interest in improving pediatric assisted ventilation. In particular, he has developed expertise in monitoring diaphragmatic function by evaluating the electrical activity of the diaphragm. The results of this work have led to less invasive and more effective assistance for children, notably with the NAVA (neurally adjusted ventilatory assist) mode.
E-mail: guillaume.emeriaud.med@ssss.gouv.qc.ca
Learning Objective: By the end of this podcast, listeners should be able to discuss the physiologic rationale and an expert approach to managing a child with respiratory failure with NAVA.
References:
Bordessoule, A., Emeriaud, G., Morneau, S. et al. Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation. Pediatr Res 72, 194–202 (2012).
Sindelar R, McKinney RL, Wallström L, Keszler M. Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants. Pediatr Pulmonol. 2021 Jul;56(7):1841-1849.
Lepage-Farrell A, Tabone L, Plante V, Kawaguchi A, Feder J, Al Omar S, Emeriaud G. Noninvasive Neurally Adjusted Ventilatory Assist in Infants With Bronchiolitis: Respiratory Outcomes in a Single-Center, Retrospective Cohort, 2016-2018. Pediatr Crit Care Med. 2024 Mar 1;25(3):201-211.
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