Trial Overview
How to deliver the intervention
UK NAVA is testing the effectiveness of neural drive monitoring and neurally-adjusted ventilatory assist.
PRINCIPLES
-The core intervention involves placing nasogastric tube into the patient safely.
-The specialised NGT is then connected to the ventilator and used to display the patient's neural drive which is otherwise invisible. This is used to establish whether a patient is breathing, how hard they are breathing, and how synchronised their breathing is to the current mode.
-Where possible the neural drive can then be used to trigger the pressure support breath, because in theory this should be more synchronised.
-If it is not possible to initiate or continue NAVA pressure support then we just need to know why.
Inclusion criteria
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Adult patients
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Likely to remain ventilated > 48 hours from randomisation
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Acute or chronic medical reason why weaning may be extended
Exclusion criteria
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Unlikely to survive >24 hours
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Receiving end-of-life care
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Contraindication to nasogastric or orogastric tube
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Severe brain injury including brain-stem damage or hypoxic brain injury or requirement for neuroprotective ventilation
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Spinal cord injury above C6 or phrenic nerve injury including Guillain Barre and Myaesthenia gravis
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Home ventilation or referred/accepted for long-term ventilation unit care
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Known/suspected portal hypertension
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Temporary or permanent pacemaker
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