Recording of a left ventricle assist device electrical current with a neurally adjusted ventilation assist (NAVA) catheter: a small case series

Background Neurally Adjusted Ventilatory Assist (NAVA) is an adaptive ventilation mode that recognizes electromyographic diaphragmatic activation as a sensory input to control the ventilator. NAVA may be of interest in prolonged mechanical ventilation and weaning, as it provides effort-adapted suppo...

Full description

Saved in:
Bibliographic Details
Published in:Journal of clinical monitoring and computing 2023-12, Vol.37 (6), p.1635-1639
Main Authors: Mohamed, M. Salaheldin Atta, Moerer, O, Harnisch, LO
Format: Article
Language:English
Subjects:
Anesthesiology
Case Report
Catheters
Critical Care Medicine
Electromyography
Health Sciences
Intensive
Medicine
Medicine & Public Health
Recording
Statistics for Life Sciences
Synchronism
Ventilation
Ventilators
Ventricular assist devices
Weaning
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Neurally Adjusted Ventilatory Assist (NAVA) is an adaptive ventilation mode that recognizes electromyographic diaphragmatic activation as a sensory input to control the ventilator. NAVA may be of interest in prolonged mechanical ventilation and weaning, as it provides effort-adapted support, improves patient-ventilator synchronization, and allows additional monitoring of neuromuscular function and drive. Ventricular assist devices (VAD), especially for the left ventricle (LVAD), are increasingly entering clinical practice, and intensivists are faced with distinct challenges such as the interaction between the system and other measures of organ support. Case presentation We present two cases in which a NAVA mode was intended to support ventilator weaning in patients with recent LVAD implantation (HeartMate III ® ). However, in these patients, the electrical activity of the diaphragm (Edi) could not be used to control the ventilator, because the LVAD current detected by the catheter superposed the Edi current, making usage of this mode impossible. Discussion/conclusions An implanted LVAD can render the NAVA signal unusable for ventilatory support because the LVAD signal can interfere with the recording of electromyographic activation of the diaphragm. Therefore, patients with implanted LVAD may need other modes of ventilation than NAVA for advanced weaning strategies.
ISSN:1387-1307
1573-2614
DOI:10.1007/s10877-023-01055-9