Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey

Daniel Hadfield; Louise Rose; Fiona Reid; Victoria Cornelius; Nicholas Hart; Clare Finney; Bethany Penhaligon; Clare Harris; Sian Saha; Harriet Noble; John Smith; Philip Anthony Hopkins; Gerrard Francis Rafferty

doi:10.1136/bmjresp-2020-000783

Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey

BMJ Open Respir Res. 2020 Dec;7(1):e000783. doi: 10.1136/bmjresp-2020-000783.

Authors

Daniel Hadfield^{1

2}, Louise Rose^{3

4}, Fiona Reid⁵, Victoria Cornelius⁶, Nicholas Hart^{7

8}, Clare Finney⁹, Bethany Penhaligon⁹, Clare Harris⁹, Sian Saha⁹, Harriet Noble⁹, John Smith⁹, Philip Anthony Hopkins^#⁹, Gerrard Francis Rafferty^#²

Affiliations

¹ Critical Care Research, King's College Hospital, London, UK daniel.hadfield@nhs.net.
² King's College London, Centre for Human and Applied Physiological Sciences, London, UK.
³ King's College London Florence Nightingale School of Nursing and Midwifery, London, London, UK.
⁴ Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK.
⁵ King's College London School of Population Health and Environmental Sciences, London, London, UK.
⁶ Imperial College London School of Public Health, London, London, UK.
⁷ Centre for Human and Applied Physiological Sciences, King's College London School of Biomedical Sciences, London, UK.
⁸ Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Trust, London, London, UK.
⁹ Critical Care Research, King's College Hospital, London, UK.

^# Contributed equally.

Abstract

Background: Neurally adjusted ventilatory assist (NAVA) involves an intricate interaction between patient, clinician and technology. To improve our understanding of this complex intervention and to inform future trials, this survey aimed to examine clinician attitudes, beliefs and barriers to NAVA use in critically ill adults within an institution with significant NAVA experience.

Methods: A survey of nurses, doctors and physiotherapists in four Intensive Care Units (ICUs) of one UK university-affiliated hospital (75 NAVA equipped beds). The survey consisted of 39 mixed open and structured questions. The hospital had 8 years of NAVA experience prior to the survey.

Results: Of 466 distributed questionnaires, 301 (64.6%) were returned from 236 nurses (78.4%), 53 doctors (17.6%) and 12 physiotherapists (4.0%). Overall, 207/294 (70.4%) reported clinical experience. Most agreed that NAVA was safe (136/177, 76.8%) and clinically effective (99/176, 56.3%) and most perceived 'improved synchrony', 'improved comfort' and 'monitoring the diaphragm' to be key advantages of NAVA. 'Technical issues' (129/189, 68.3%) and 'NAVA signal problems' (94/180, 52.2%) were the most cited clinical disadvantage and cause of mode cross-over to Pressure Support Ventilation (PSV), respectively. Most perceived NAVA to be more difficult to use than PSV (105/174, 60.3%), although results were mixed when compared across different tasks. More participants preferred PSV to NAVA for initiating ventilator weaning (93/171 (54.4%) vs 29/171 (17.0%)). A key barrier to use and a consistent theme throughout was 'low confidence' in relation to NAVA use.

Conclusions: In addition to broad clinician support for NAVA, this survey describes technical concerns, low confidence and a perception of difficulty above that associated with PSV. In this context, high-quality training and usage algorithms are critically important to the design and of future trials, to clinician acceptance and to the clinical implementation and future success of NAVA.

Keywords: assisted ventilation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Critical Care
Humans
Interactive Ventilatory Support*
Positive-Pressure Respiration
Surveys and Questionnaires
Ventilator Weaning

Grants and funding

CDRF-2014-05-056/DH_/Department of Health/United Kingdom