Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis

Abstract

Prolonged ventilatory support is associated with poor clinical outcomes. Partial support modes, especially pressure support ventilation, are frequently used in clinical practice but are associated with patient–ventilation asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient–ventilator asynchrony, may be an alternative for weaning. However, the effects of NAVA on weaning outcomes in clinical practice are unclear. We searched PubMed, Embase, Medline, and Cochrane Library from 2007 to December 2020. Randomized controlled trials and crossover trials that compared NAVA and other modes were identified in this study. The primary outcome was weaning success which was defined as the absence of ventilatory support for more than 48 h. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with accompanying 95% confidence interval (CI) were expressed. Seven studies (n\u2009=\u2009693 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with other partial support modes (OR\u2009=\u20091.93; 95% CI 1.12 to 3.32; P\u2009=\u20090.02). For the secondary outcomes, NAVA may reduce duration of mechanical ventilation (MD\u2009=\u2009− 2.63; 95% CI − 4.22 to − 1.03; P\u2009=\u20090.001) and hospital mortality (OR\u2009=\u20090.58; 95% CI 0.40 to 0.84; P\u2009=\u20090.004) and prolongs ventilator-free days (MD\u2009=\u20093.48; 95% CI 0.97 to 6.00; P\u2009=\u20090.007) when compared with other modes. Our study suggests that the NAVA mode may improve the rate of weaning success compared with other partial support modes for difficult to wean patients.