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Neurally Adjusted Ventilatory Assist

It’s not mindreading, but close.[1],[2]

Imagine being able to see and deliver what your patients want, while their own natural respiratory drive controls the ventilator. We call it Neurally Adjusted Ventilatory Assist (NAVA). It is based on close monitoring of the output of the patient’s respiratory center, by capturing the electrical signal that activates the diaphragm (Edi), using a dedicated gastric feeding tube (Edi catheter). NAVA shortens the time of mechanical ventilation[3] and increases the number of ventilator-free days[3] [4] [5] by providing personalized ventilation that is both lung- and diaphragm-protective.

See and deliver what your patient wants

In most intensive care units, 20% of the patients consume 80% of ventilation resources, which may lead to increased complications and unwanted outcomes. [31] For these patients, conventional ventilation simply isn’t enough. By using the NAVA mode on Servo ventilators, which works regardless of patient category or size, the ventilator shows you what the patient wants. Together with other personalized ventilation tools, this can help you reduced complications [9] [10] [29] [30], monitor and reduce sedation [5] [19] [20] [21], achieve earlier and more successful weaning [3] [4] [8] [13] [14] and shorten the time of mechanical ventilation [3] [20] [21].

How NAVA delivers a more personalized level of ventilation in three easy steps.

How NAVA delivers a more personalized level of ventilation in three easy steps.

Related products

Achieve faster personalized weaning with lung- and diaphragm-protective ventilation

Monitor Edi – the vital sign of respiration, from day zero

1. Monitor Edi – the vital sign of respiration, from day zero

Protect and activate the diaphragm to wean earlier

2. Protect and activate the diaphragm to wean earlier

Protect the lungs in synchrony with the patient

3. Protect the lungs in synchrony with the patient

4. Improve the patient’s overall ICU experience

Servo-u ventialtor NAVA with EDI curve graphic

Monitor Edi – the vital sign of respiration

In addition to monitoring the impact of mechanical ventilation on lung function, it is also imperative to monitor patient respiratory drive and effort from day zero. Edi monitoring facilitates earlier and more informed decision-making. With this vital sign in your lower screen, you can detect diaphragm inactivity, over-sedation, patient-ventilator asynchrony as well as over- and under-assist. You can also monitor increased work-of-breathing during weaning trials and post-extubation[5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15].

Personalized weaning

Diaphragm-protective ventilation

Suboptimal mechanical ventilation can rapidly cause acute diaphragm atrophy or load-induced injury associated with poor clinical outcomes [16] [17]. The key physiological benefits of NAVA are that pressure is always delivered in proportion to and in synchrony with the patient’s own respiratory drive, and that Edi is readily available as a bedside diagnostic tool [1] [2]. NAVA shortens the duration of weaning and increases the proportion of patients with successful weaning[3][4].

Personalized lung protection

Lung-protective ventilation

A key difference between NAVA and conventional support modes is that tidal volume (VT) is controlled via neuro-electrical output from the patient’s respiratory center. Lung over-distension is thus prevented thanks to the Hering-Breuer reflex, which down-regulates the respiratory drive at higher tidal volumes to avoid hyperinflation. As a result, it is possible to achieve lung-protective spontaneous breathing within the protective range of 6-8 ml/kg [1] [2] [18] PBW.

Improved patient experience

Improved patient experience

NAVA has been shown to improve the patient’s overall ICU experience, helping clinicians to potentially reduce sedation with improved comfort and sleep quality [19] [20] [21] [22] [23]. Together, Edi and NAVA assure that the breathing efforts from all patient categories are effectively assessed and responded to. For patients with acute exacerbation of COPD, our non-invasive, leakage-independent NIV NAVA mode can be helpful effective in managing their status and avoiding intubation [14] [24] [25] [26] [27] [28].

Personalized support throughout the treatment

illustration nava

Invasive NAVA

Synchronized assist, weaning and sedation management, supporting early diaphragm activation.

Illustation non-invasive nava

Non-invasive NAVA


Synchronized assist, independent of leakages allowing a gentler mask application.

illustration monitoring

Edi monitoring

Monitor diaphragm activity and breathing effort after extubation. Can be used with High Flow therapy if needed.

  • Servo-u gives you many options for personalized lung protection and weaning, for treatment of all patient categories. All are easy to understand, implement and use.

  • Servo-n offers an advanced all-in-one solution for personalized lung protection and weaning, helping neonates breathe, sleep and grow.

  • Achieve faster personalized weaning with lung and diaphragm-protective ventilation.

  • Diaphragm monitoring, helping you improve mechanical ventilation

  • Detect electrical activity of diaphragm, with our range of Edi catheters, enabling NAVA and NIV NAVA ventilation modes, and available in all patient categories.

Improve your knowledge with our eLearning and training courses

At Getinge Educational Institute, we have dedicated material for topics related to Intensive Care, Cardiovascular Procedures, Operating Room and Sterile Processing. We can support you with information about current technologies and best practices to boost your performance and productivity.

For more information about our onsite events or remote trainings, you can also contact your local sales & service representative.

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  2. 2. Jonkmann A, et al. Proportional modes of ventilation: technology to assist physiology Intensive Care Med. 2020 Aug 11;1-13.

  3. 3. Kacmarek R, et al. Neurally adjusted ventilatory assist in acute respiratory failure: a randomized controlled trial. Intensive Care Med 2020. Sep 6 : 1–11.

  4. 4. Liu L, et al. Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation in Difficult Weaning. A Randomized Trial. Anesthesiology. 2020 Jun;132(6):1482-1493.

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  6. 6. ATS/ERS Statement on Respiratory Muscle Testing. American Journal of Respiratory and Critical Care Medicine, 2002166(4), pp. 518-624.

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  10. 10. Yonis H, et al. Patient-ventilator synchrony in Neurally Adjusted Ventilatory Assist (NAVA) and Pressure Support Ventilation (PSV). BMC Anesthesiol. 2015 Aug 8;15:117.

  11. 11. Cecchini J, et al. Increased diaphragmatic contribution to inspiratory effort during neurally adjusted ventilatory assistance versus pressure support: an electromyographic study. Anesthesiology. 2014 Nov;121(5):1028-36.

  12. 12. Di Mussi R, et al. Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV. Crit Care. 2016 Jan 5;20(1):1.

  13. 13. Barwing J, et al. Electrical activity of the diaphragm (EAdi) as a monitoring parameter in difficult weaning from respirator: a pilot study. Crit Care. 2013 Aug 28;17(4):R182.

  14. 14. Bellani G, Pesenti A. Assessing effort and work of breathing. Curr Opin Crit Care. 2014 Jun;20(3):352-8.

  15. 15. Bellani G, et al. Clinical assessment of autopositive end-expiratory pressure by diaphragmatic electrical activity during pressure support and neurally adjusted ventilatory assist. Anesthesiology. 2014 Sep;121(3):563-71.

  16. 16. Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med. 2017 Oct;43(10):1441-1452.

  17. 17. Goligher EC, Hodgson CL, Adhikari NKJ, et al. Lung recruitment maneuvers for adult patients with acute respiratory distress syndrome. Ann Am Thorac Soc 2017;14:S304-11.

  18. 18. Patroniti N, et al. Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients. Intensive Care Med. 2012 Feb;38(2):230-9.

  19. 19. De la Oliva P, et al. Asynchrony, neural drive, ventilatory variability and COMFORT: NAVA versus pressure support in pediatric patients. Intensive Care Med. 2012 May;38(5):838-46.

  20. 20. Piastra M, et al. Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: nested study. J Crit Care. 2014 Apr;29(2):312.e1-5.

  21. 21. Kallio M, et al. Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care – a randomized controlled trial. Pediatr Pulmonol. 2015 Jan;50(1):55-62.

  22. 22. Delisle S, et al. Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes. Ann Intensive Care. 2011 Sep 28;1(1):42.

  23. 23. Delisle S, et al. Effect of ventilatory variability on occurrence of central apneas. Respir Care. 2013 May;58(5):745-53.

  24. 24. Doorduin J, et al. Automated patient-ventilator interaction analysis during neurally adjusted noninvasive ventilation and pressure support ventilation in chronic obstructive pulmonary disease. Crit Care. 2014 Oct 13;18(5):550.

  25. 25. Kuo NY, et al. A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation. International Journal of COPD. 2016 11;11:945-51.

  26. 26. Sun Q, et al. Effects of neurally adjusted ventilatory assist on air distribution and dead space in patients with acute exacerbation of chronic obstructive pulmonary disease. Crit Care 2017 2;21(1):126.

  27. 27. Karagiannidis C, et al. Control of respiratory drive by extracorporeal CO 2 removal in acute exacerbation of COPD breathing on non-invasive NAVA. Crit Care 2019 Apr 23;23(1):135.

  28. 28. Prasad KT, et al. Comparing Noninvasive Ventilation Delivered Using Neurally-Adjusted Ventilatory Assist or Pressure Support in Acute Respiratory Failure. Resp Care 2020 Sep 1;respcare.07952.

  29. 29. Blankman P, et al. Ventilation distribution measured with EIT at varying levels of PS and NAVA in Patient with ALI. Intensive Care Med. 2013 Jun;39(6):1057-62.

  30. 30. Patroniti N, et al. Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients. Intensive Care Med. 2012 Feb;38(2):230-9.

  31. 31. Icuregswe.org. (2016). Start - SIR-Svenska Intensivvardsregistret. [online] Available at: http://www.icuregswe.org/en/ [Accessed Dec 2. 2015].

    http://www.icuregswe.org/en/