EC Paediatrics

Introduction: Mechanical ventilation is essential in managing respiratory failure in neonates and children, but conventional modes often lead to patient-ventilator asynchrony, contributing to lung injury and prolonged support. Neurally Adjusted Ventilatory Assist (NAVA) is an innovative mode that uses the electrical activity of the diaphragm to synchronize ventilation with the patient’s neural respiratory drive. This systematic review evaluates randomized controlled trials comparing NAVA with conventional ventilation modes in neonates and pediatric populations. The objective is to assess NAVA’s impact on respiratory synchrony, ventilator-free days, lung injury, weaning outcomes, and overall morbidity and mortality in this vulnerable cohort.

Study Design: This systematic review was conducted following PRISMA [25] guidelines. Randomized controlled trials (RCTs) published from 2000 onward were included to compare Neurally Adjusted Ventilatory Assist (NAVA), both invasive and non-invasive, with conventional ventilation strategies in neonates and pediatric patients. Studies were identified through comprehensive searches of PubMed, Scopus, Embase, and the Cochrane Library. Only peer-reviewed RCTs reporting on respiratory outcomes, synchrony, weaning, or morbidity was included. Case reports, observational studies, and non-RCTs were excluded.

Eligibility criteria (PICO framework):

• Population: Neonates and pediatric patients requiring mechanical ventilation.
• Intervention: NAVA ventilation.
• Comparison: Conventional ventilation (pressure- or volume-controlled).
• Outcomes: Respiratory synchrony, ventilator-free days, incidence of bronchopulmonary dysplasia (BPD) and lung injuries (e.g., barotrauma), ease of weaning, morbidity, and mortality.

Results: A total of 24 RCTs comprising 563 patients (NAVA = 287; control = 276) were included. Twenty studies (83%) reported a statistically significant reduction in patient-ventilator asynchrony with NAVA (mean difference range: -5.2% to -11.8%, p < 0.05). Eight trials (33%) demonstrated shorter ventilation duration in the NAVA group, though results were heterogeneous. Five studies reported lower oxygen requirements or improved oxygenation indices. Incidence of bronchopulmonary dysplasia (BPD) was lower in the NAVA group in three of five trials assessing this outcome. No study reported increased adverse events with NAVA. Outcome measures varied, limiting quantitative synthesis.

 Keywords: NAVA; Neurally Adjusted Ventilator Assist; Patient Ventilator Asynchrony; BPD; Ventilator Weaning; Neonatal Ventilation; Paediatric Critical Care

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