King's College London

Usual ventilator weaning involves the manual adjustment of support settings, which often means treatment is not matched to patient need, resulting in extended duration of ventilation and worse patient outcomes.

In contrast, innovative automated ventilation systems such as Neurally Adjusted Ventilatory Assist (NAVA), adapt the ventilator support automatically according to physiological parameters. In NAVA, the activity of the diaphragm muscle is used as a monitor of respiratory drive, and to deliver proportional pressure support in synchrony with a patient’s changing ventilatory need.

NAVA technology uses a specialised nasogastric tube (NGT) to obtain the electrical activity of the diaphragm (EDi) muscle, which is a reliable index of the patient’s respiratory drive. Once the NAVA NGT is placed, the EDi is always visible to clinicians, allowing optimisation of ventilator settings in any mode. When the NAVA mode is active, the ventilator triggers, cycles and adjusts support in synchrony and proportion to the EDi.

The UKNAVA trial aims to address the knowledge gap with an adequately powered and rigorous trial comparing NAVA technology to usual care. UKNAVA also addresses a priority of the James Lind Alliance ICU priority setting partnership, ‘What is the best way of preventing lung damage of patients receiving respiratory support?’

The project investigators are Prof Danny McAuley, Prof Gary Mills, Dr Reinout Mildner, Prof Louise Rose, Dr Gerard Rafferty, Ms Caroline Murphy, Prof Gavin Perkins, Dr Huajie Jin, Prof Nicholas Hart, Prof Luigi Camporota, Ms Chantal Davies.