Dr. Guillaume Emeriaud, a Professor of Pediatrics and pediatric intensivist, shares his insights on Neurally Adjusted Ventilatory Assist (NAVA) in critically ill children. He discusses optimizing non-invasive ventilation and the importance of monitoring diaphragmatic activity for effective respiratory support. Key challenges include managing airflow leaks and balancing sedation with ventilation needs. Emeriaud also highlights future directions for NAVA in pediatric care, emphasizing the necessity for personalized observation and institutional knowledge.
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volunteer_activism ADVICE
Practical Initial NAVA Settings
Start with the PEEP you were using and set NAVA around 0.7–0.8 as Guillaume Emeriaud recommends.
Use the max-pressure alarm to limit delivered pressure and aim for a decreasing EDi over time.
volunteer_activism ADVICE
Use EDi Alongside Clinical Signs
Use EDi as additional data, not the sole determinant of support adequacy, as Guillaume Emeriaud explains.
Prioritize clinical signs like respiratory rate, heart rate, and comfort alongside EDi trends.
volunteer_activism ADVICE
Fix Leaks Before Turning Up Support
Check interface leaks because they reduce the actual pressure the patient receives and can make NAVA ineffective.
If delivered pressure is low due to leaks, fix the interface rather than increasing the NAVA level.
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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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