PT  - JOURNAL ARTICLE
AU  - Weiyun Teng
AU  - Linli Sang
AU  - Liuzhao Cao
TI  - Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation (PSV) during non-invasive ventilation (NIV): systematic review and meta-analysis
AID  - 10.4187/respcare.09881
DP  - 2022 Feb 17
TA  - Respiratory Care
PG  - respcare.09881
4099  - http://rc.rcjournal.com/content/early/2022/02/17/respcare.09881.short
4100  - http://rc.rcjournal.com/content/early/2022/02/17/respcare.09881.full
AB  - Background: Non-invasive ventilation is increasingly used as a respiratory support therapy. Neurally adjusted ventilatory assist (NAVA) is a novel mode of mechanical ventilation, which could improve patient-ventilator interaction.Objective: Implement a meta-analysis to compare patient-ventilator interaction and clinical outcomes between NAVA and pressure support ventilation (PSV) in adult patients during NIV.Methods: The Pubmed, Cochrane Library, Web of science, OpenGrey and Embase databases were searched for appropriate clinical trials comparing NIV-NAVA with NIV-PSV for adult patients. Comparisons of asynchrony index (AI), types of asynchrony and clinical outcomes were pooled.Results: 15 studies were included involving 615 subjects. AI was significantly lower in NAVA than PSV group (MD -14.70, 95% CI: -23.20 to -6.19, P < 0.001). Subgroup analysis grouped by exacerbation of chronic obstructive pulmonary diseases (COPD) or non-COPD showed that the AI of NAVA was lower than PSV in COPD exacerbation (MD -14.56, 95% CI: -21.04 to -8.09, P < 0.001) and non-COPD (MD -3.02, 95% CI: -4.44 to -1.61, P < 0.001). Severe asynchrony was significantly lower in NAVA than in PSV (OR 0.06, 95% CI: 0.03 to 0.11, P < 0.001). Inspiratory trigger delay in NAVA was significantly lower than PSV (MD -129.60, 95% CI: -148.43 to -110.78, P < 0.001). NAVA had longer ICU duration than PSV (MD 1.22, 95% CI: 0.44 to 2.00, P = 0.002). Level of discomfort was significantly higher in NAVA group than PSV group (MD 0.62, 95% CI: 0.02 to 1.21, P = 0.04).Conclusion: NAVA has more advantages in ventilator-patient interaction than PSV in NIV. Further high quality research is needed in order to estimate effects on clinical outcomes.