About
OTriaO
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Our Trial
Neurally-adjusted ventilatory assist (NAVA) technology involves two related interventions aimed at improving ventilatory support. The idea is to try and make ICU staff aware of patient neural drive and improve the comfort of ventilation and get critically-ill patients off ventilators quicker.
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NAVA Monitoring. Electrodes on an adapted naso-gastric tube allow critical care staff to see and monitor the neural drive (nerve impulses passing down the phrenic nerve to the diaphragm) of a patient.
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NAVA Mode. Secondly, the same neural drive signal can be used to initiate and synchronise pressure support breaths. This should improve the efficiency and comfort of pressure support and mean that the lung is distended more evenly.
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Both nasogastric tubes and pressure support ventilation are very familiar to critical care staff, and this should help in the delivery of the UK NAVA trial, because these comprise the trial intervention. Whilst there is extensive observational evidence to show NAVA technology (NAVA Monitoring + NAVA Mode) offers an advantage over standard ventilation, there has never been an adequately powered trial of the technology to show that it is clinically effective. Importantly, the issues/challenges around introducing new technology in busy intensive care units need to be shown to be offset by very clear clinical advantages that benefit staff patients and their families.
Our research question was formulated over several years; and further refined by the experience of the COVID19 pandemic. We have worked hard to try and make it possible to answer this question in busy intensive care units where staff are under huge pressures. We know that the trial will only work if we have buy-in from the whole interprofessional team who are caring for patients. We want the answer to the trial to mean something to these professionals; our patients and their families.
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Our question
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Will NAVA technology (NAVA monitoring in combination with NAVA mode-two sides of the same coin)- decrease the time patients spend on ventilators when they have risk factors for extended weaning?
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Our Plan
How do we want to answer this question?
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We will randomise patients to standard care or NAVA technology (NAVA monitoring-NAVA mode). We will compare the time that patients spend on ventilators as well as looking at important secondary outcomes including long-term recovery.
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We will do this across 40 ICUs across the UK and we will aim to involve all professionals who work in critical care. This includes nurses, doctors and other allied healthcare professionals. This is because patient-ventilator management involves the whole team.
Our Team
Dr Daniel Hadfield
Co Chief Investigator
Dr Hadfield is a Post Doctoral Researcher at King's College London and Joint Chief Investigator of UK NAVA
Dr Phil Hopkins
Co Chief Investigator
Dr Phil Hopkins is an Hon Senior Lecturer in Intensive Care Medicine at KCL and joint Chief Investigator of UK NAVA
Professor Louise Rose
Co-investigator
Professor Louise Rose is Professor of Critical Care Nursing & Head of Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, KCL
Professor Danny McCauley
Co-investigator
Professor Danny McCauley is Professor of Intensive Care Medicine at the Wellcome-Wolfson Institute of Experimental Medicine, Queen's University, Belfast
Professor Gavin Perkins
Co-Investigator
Professor Gavin Perkins is Professor of Critical Care Medicine at the University of Warwick
Professor Luigi Camporata
Co-Investigator
Dr Luigi Camporata is an Associate Professor/Reader at KCL and Consultant in Critical Care/ECMO Service at Guys & St Thomas' Hospital, London. He is Chair of the Acute Respiratory Failure section of the European Society of Intensive Care Medicine
Professor Gary Mills
Co-Investigator
Professor Gary Mills is Professor of Critical Care & Peri-operative Medicine, University of Sheffield
Professor Nicholas Hart
Co-Investigator
Professor Nicholas Hart is Professor of Respiratory and Critical Care Medicine, KCL
Prof Ged Rafferty
Co-investigator
Prof Ged Rafferty is a Professor in Human & Translational Physiology, KCL
Prof Bronwyn Connolly
Co-investigator
Prof Bronwen Connolly is a critical care physiotherapist, and Professor in Critical Care at Queen's University Belfast, UK
Dr. Huajie Jin (Lily)
Co-Investigator
Senior Lecturer and Deputy Head at King’s Health Economics (KHE), Institute of Psychiatry, Psychology, and Neuroscience at King’s College London
Maddy Hill
Trial Manager
Warwick Clinical Trials Unit
Kirsty Lea
Clinical Trials Manager
Warwick Clinical trials Unit
Louise Payne
UK NAVA Practice Nurse
King's Critical Care
"This is such important work - thank you for involving patients and their loved ones in this amazing project."
King's Critical Care Pathfinder Past Patient
"Being stuck on the breathing machine was the worst experience of my life-even a minute shorter to get off that thing would be worth it. It is truly indescribable."
King's Critical Care Pathfinder-Past Patient
"If this works it would be such a game changer-I really want to help to get this off the ground especially as I thing if anyone goes through what my husband did, even small improvements would be so so important-Thank you for thinking of us."
King's Critical Care Pathfinder-Past Patient Relative