Feature | October 03, 2006 | Kim Phelan

Getting Our Brains Around a Whole New Ventilation Methodology

Kim Phelan, Editor

Mechanical ventilation has a weighty presence in this issue — we offer our annual ventilator comparison chart as well as professional insights about advanced ventilator features in a physician-authored article beginning on page 28. Many thanks to this magazine’s Editorial Advisory Board member Dr. Girish Joshi at University of Texas Southwestern Medical Center and his colleagues for their important contribution.
By coincidence, I learned about a new ventilation technology a few weeks ago and quickly became eager to investigate further. Could it be remotely possible for the ICU-ventilated patient to be put in control of his or her own ventilation — brain signals literally telling a ventilator when and how much assistance to provide?
After reading an interview with researcher Christer Sinderby, Ph.D., published in a recent issue of Critical Care News by Maquet and reprinted here (starting on page 27), it became evident to me that his Neurally Adjusted Ventilator Assist (NAVA) device is likely to become, as he says, “the paradigm shift in mechanical ventilation.”
I called Dr. Sinderby to get a better understanding of how the thing actually works.
Essentially, according to Sinderby, NAVA utilizes a feeding tube attached with tiny electrodes, which is advanced down the esophagus. Using Sinderby’s patented technique to ensure consistently accurate positioning, the tube (in the future, a specially manufactured catheter) is placed at the diaphragm just above the stomach. It is this device that captures neurological electric signals from the patient’s brain that are sent to diaphragm muscles, instructing them when and how to take an inspiration. The brain signals are viewable on Sinderby’s monitor, which, he says, could conceivably be a separate instrument compatible and attachable to any ventilator.
But when attached to his NAVA system, which is also comprised of an amplifier and processor, the results — as he has demonstrated before hundreds of respiratory therapists and anesthesiologists — are that “you can ventilate with 100 percent synchrony.
“This is a brain signal you are picking up,” said Sinderby. “You are measuring the need to breath...not how much you breath. [The patient’s] brain is controlling it.”
Because the system responds to what the brain is signaling (starting, stopping and how much assistance to give), the implications for noninvasive ventilation are significant.
“You have the advantage of keeping the airway free,” he said. “You don’t have to invade the airway with anything. You can put the mask on the face [or] you can put the mask over the nose. As long as you can deliver enough pressure for the airway, that is enough to help [the patient] breathe.”
And when physicians and respiratory therapists choose noninvasive methods of airway management, mortality rates drop, says Sinderby. The value of the NAVA approach with noninvasive assistance, he adds, is especially powerful for the ventilation of neonates (as well as term babies), a difficult patient population to synchronize.
Sinderby and his associates have been working on the development of NAVA in Toronto for about 10 years, having created their own prototype and using ventilators from Siemens and Maquet. And at last, according to Sinderby, the technology is nearing the threshold of commercial availability in Europe. He said that at the end of September (while we’re still at press) he is presenting at the meeting of the European Society of Intensive Care Medicine, where Maquet will announce its campaign launch for a ventilator that incorporates the NAVA system.
Please return here for our December/January issue where I will provide as much information as possible on the status of this new product as well as any available forecasts for its future arrival into the U.S. healthcare marketplace.
I hope you find good things to take away from these pages, and as always, thanks for reading!

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