Recording of a left ventricle assist device electrical current with a neurally adjusted ventilation assist (NAVA) catheter: a small case series,Journal of Clinical Monitoring and Computing

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Recording of a left ventricle assist device electrical current with a neurally adjusted ventilation assist (NAVA) catheter: a small case series
Journal of Clinical Monitoring and Computing ( IF 2.0 ) Pub Date : 2023-07-17 , DOI: 10.1007/s10877-023-01055-9
M Salaheldin Atta Mohamed ₁ , O Moerer ₁ , L O Harnisch ₁

Affiliation

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.

中文翻译：

使用神经调节通气辅助 (NAVA) 导管记录左心室辅助装置电流：小病例系列

背景

神经调节通气辅助 (NAVA) 是一种自适应通气模式，可将肌电图膈肌激活识别为控制呼吸机的感觉输入。NAVA 可能对延长机械通气和撤机感兴趣，因为它提供了适应努力的支持，改善了患者与呼吸机的同步，并允许对神经肌肉功能和驱动力进行额外监测。心室辅助装置（VAD），特别是左心室（LVAD），越来越多地进入临床实践，重症监护医生面临着独特的挑战，例如系统与其他器官支持措施之间的相互作用。