NAVA – a gamechanger for neonatal care in Slovakia
When using Getinge’s patented Neurally Adjusted Ventilatory Assist (NAVA) with diaphragm monitoring (Edi) for the first time in 2021, it soon became clear to the neonatal team in the F.D. Roosevelt University Hospital in Banska Bystrica, Slovakia, that the solution would become a gamechanger for their treatment of premature babies.
The first case for the F.D. Roosevelt University Hospital in Banska Bystrica using NAVA involved a tiny premature girl, born in the 22nd week, who developed severe Bronchopulmonary Dysplasia (BPD).
“She was in such poor condition that we couldn’t use traditional ventilation anymore, and our options for the baby were limited. We were still learning how to use NAVA at the time, but encouraged by exceptionally positive experiences from a recent workshop, we decided to try it on the little girl before we gave up,” says Andrea Ivanková, neonatologist at the Department of Neonatology in Banska Bystrica.
The NAVA treatment, which uses the patient’s own respiratory drive to control the assistance of the ventilator, was successful. The baby’s condition improved. She was already on spontaneous ventilation when she was transferred to another hospital where she spent some time before being discharged.
“The successful outcome gave us confidence to use NAVA on more and more neonates. After initially focusing the treatment on the most severe BPD cases, we now have a more proactive approach that helps us to prevent the lung condition from occuring,” Andrea explains.
The NAVA journey in Banska Bystrica began when Dr. Jana Nikolinyová, Head of the Neonatal Intensive Care Unit (NICU), attended a workshop in Finland. In the following years, she dedicated a lot of effort to get the right equipment and expertise in place.
Andrea Ivanková joined the team in 2019, and she describes her experiences from her first NAVA workshop as “mind-blowing”.
“I instantly felt that the technology is the future for us and our tiny patients. It makes the babies more comfortable and helps us improve the outcome of their stay with us in the NICU,” she says.
Since the beginning, the team in central Slovakia has treated 34 NAVA patients, and the experience in the team is growing.
“For me, peer-to-peer events continue to be valuable for keeping up with the latest data, as well as for discussing and discovering potential improvements. In the most recent workshop, which we organized, I shared the experiences of the signals from the Edi catheter, which is designed to detect the baby’s own breathing efforts. Our patients are way too small to speak, but the Edi signals help us understand what they are trying to tell us,” Andrea says.
The increased understanding of the diaphragm monitoring has resulted in a change of the approach in the NICU in Banska Bystrica.
“Previously, we used to remove the catheter when the baby was ready for traditional ventilation. Now we keep it for a while. Continuing to monitor the Edi signal even when the baby is doing better provides us with vital information that can help improve the outcome,” Andrea concludes.
About NAVA
NAVA, which has been used exclusively by Getinge since it was invented in the mid-1990s, is based on the breathing control from the patient´s brain stem. By using a special Edi catheter to capture the electrical signal that activates the human diaphragm, the ventilator continuously becomes fully synchronized with the patient´s own breathing efforts.
The NAVA modes (NAVA, NIV-NAVA and Edi monitoring), available for Getinge’s Servo-u, Servo-n and Servo-i ventilators, are able to help all types of patients breathe; from tiny premature babies weighing a few hundred grams to the oldest patients, aged 90 or above.
This text is intended to provide information to an international audience outside of the US.