With NAVA and Edi
Personalized ventilation provides unique patient insight and ventilation capabilities. It consists of a diagnostic tool that helps you monitor diaphragm activity (Edi) on the ventilator screen and a ventilation mode (NAVA®) that uses the diaphragm activity to deliver assist adapted to the patient.
Personalized ventilation can help you:
- reduce complications1-4
- increase patient comfort5-7
- reduce sedation5-7 and
- wean patients earlier.8-10
Support throughout the treatment
Synchronized assist, weaning and sedation management, supporting early diaphragm activation.
Synchronized assist, independent of leakages allowing a gentler mask application.
Monitor diaphragm activity and breathing effort after extubation. Can be used with High Flow therapy if needed.
NAVA and Edi benefits are well documented
- Yonis H, et al. Patient-ventilator synchrony in Neurally Adjusted Ventilatory Assist (NAVA) and Pressure Support Ventilation (PSV). BMC Anesthesiol. 2015 Aug 8;15:117.
- Piquilloud L, et al. Neurally adjusted ventilatory assist improves patient-ventilator interaction. Intensive Care Med. 2011 Feb;37(2):263-71.
- Blankman P, et al. Ventilation distribution measured with EIT at varying levels of PS and NAVA in Patients with ALI. Intensive Care Med. 2013 Jun;39(6):1057-62.
- Patroniti N, et al. Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients. Intensive Care Med. 2012 Feb;38(2):230-9.
- Kallio M, et al. Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care – a randomized controlled trial. Pediatr Pulmonol. 2015 Jan;50(1):55-62.
- Piastra M, et al. Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: nested study. J Crit Care. 2014 Apr;29(2):312.e1-5.
- De la Oliva P, et al. Asynchrony, neural drive, ventilatory variability and COMFORT: NAVA versus pressure support in pediatric patients. Intensive Care Med. 2012 May;38(5):838-46.
How to see and deliver what your patient wants
In most intensive care units 20% of patients consume 80% of ventilation resources, which may lead to increased complications and unwanted outcomes.1 For these patients conventional ventilation simply isn’t enough. With personalized ventilation, the ventilator shows you what the patient wants, which may help you wean earlier with increased comfort, decreased sedation and reduced complications.
1. Identify common ventilator challenges
Only 10% of experienced clinicians detect auto-triggering, one of many challenges that can result in patient-ventilator agitation, increased sedation and delayed weaning. This is because the ventilator waveforms show you what the ventilator delivers, not what the patient wants.2
Seeing patient diaphragm activity on screen (Edi) helps you:
2. Keep the diaphragm active
Edi helps you detect diaphragm activity early and Neurally Adjusted Ventilatory Assist (NAVA) helps you exercise the diaphragm on a personalized level.7,8
3. Protect the lung from injury and wean earlier
An active diaphragm is the first step towards successful weaning. The second step is to avoid lung injury. NAVA delivers assist in proportion to and in synchrony with the patient’s respiratory efforts, which can contribute to:
- Icuregswe.org. (2016). Start - SIR-Svenska Intensivvardsregistret. [online] Available at: http://www.icuregswe.org/en/ [Accessed Dec 2. 2015].
- Colombo D, et al. Efficacy of ventilatorwaveforms observation in detecting patient–ventilator asynchrony. Crit Care Med. 2011.
- Ducharme-Crevier L, et al. Interest of Monitoring Diaphragmatic Electrical Activity in the Pediatric Intensive Care Unit. Crit Care Res Pract. 2013;2013:384210.
- Emeriaud G, Beck J, Tucci M, Lacroix J, Sinderby C. Diaphragm electrical activity during expiration in mechanically ventilated infants. Pediatr Res 2006 59: 705-710
- Beck J, Reilly M, Grasselli G, Qui H, Slutsky AS, Dunn MS, Sinderby CA. Characterization of Neural Breathing Pattern in Spontaneously Breathing Preterm Infants. Pediatr Res. 2011 Aug 18. [Epub ahead of print]
- Delisle S, et al. Effect of ventilatory variability on occurrence of central apneas. Respir Care. 2013 May;58(5):745-53.
- Delisle S, et al. Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes. Ann Intensive Care. 2011 Sep 28;1(1):42.
How personalized ventilation works
During normal respiration, a spontaneous breath begins with an impulse generated by the respiratory centers in the brain. This impulse is then transmitted via phrenic nerves and electrically activates the diaphragm, leading to a muscle contraction. The diaphragm contracts into the abdominal cavity, which leads to a descending movement, creating a negative alveolar pressure and an inflow of air.
The signal that excites the diaphragm is proportional to the integrated output of the respiratory center in the brain and controls the depth and cycling of the breath.
With personalized ventilation the electrical discharge of the diaphragm is captured by a special catheter fitted with an array of electrodes (the Edi catheter) and visualized on the ventilator screen. This is Edi, the electrical activity of the diaphragm. The Edi catheter is placed in the esophagus much like an ordinary feeding tube. With NAVA, Neurally Adjusted Ventilatory Assist, the Edi is used to deliver ventilation in time with and in proportion to the diaphragm activity.
The benefits of Edi monitoring
The diaphragm is the “heart” of the respiratory system and is designed to be continuously active.1 The Edi is a bedside diagnostic tool that allows you to monitor and safeguard the patients diaphragm activity.2,3 The Edi guides weaning4 and helps you prevent muscular exhaustion during weaning trials, even after extubation.5
How to detect an inactive diaphragm
Below notice how the pressure curve (yellow) to the middle and to the right seems just fine, even though the diaphragm as demonstrated by the Edi signal (pink) is inactive compared to the image on the left where the pressure curve follows the shape of the Edi signal.
How to detect patient ventilator-asynchrony
Identifying any of the many asynchronies is just as easy. Below are a few examples of asynchronies visible directly on the screen, continuously.
- Perry SF, et al. The evolutionary origin of the mammalian diaphragm. Respir Physiol Neurobiol. 2010 Apr 15;171(1):1-16.
Personalized Ventilation BrochurePersonalized Ventilation Brochure
Edi Catheter Data SheetEdi catheter technical specifications, selection guidelines and ordering information
Edi cathether ENFit Datasheet
NAVA and NIV NAVA Neonatal Pocket GuideNAVA and NIV NAVA in neonatal settings
NAVA and Edi Monitoring - Better Patient SatisfactionBetter patient satisfaction through better breathing
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