Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey
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 us...
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doaj-c5326d518bf74cccb291e2cada917b5b2021-02-01T14:31:35ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392020-05-017110.1136/bmjresp-2020-000783Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician surveyFiona Reid0Nicholas Hart1Louise Rose2John Smith3Clare Harris4Victoria Cornelius5Gerrard Francis Rafferty6Daniel Hadfield7Clare Finney8Bethany Penhaligon9Sian Saha10Harriet Noble11Philip Anthony Hopkins12King's College London School of Population Health and Environmental Sciences, London, London, UKCentre for Human and Applied Physiological Sciences, King's College London School of Biomedical Sciences, London, UKKing's College London Florence Nightingale School of Nursing and Midwifery, London, London, UKCritical Care Research, King's College Hospital, London, UKCritical Care Research, King's College Hospital, London, UKImperial College London School of Public Health, London, London, UKKing's College London, Centre for Human and Applied Physiological Sciences, London, UKCritical Care Research, King's College Hospital, London, UKCritical Care Research, King's College Hospital, London, UKCritical Care Research, King's College Hospital, London, UKCritical Care Research, King's College Hospital, London, UKCritical Care Research, King's College Hospital, London, UKCritical Care Research, King's College Hospital, London, UKBackground 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.https://bmjopenrespres.bmj.com/content/7/1/e000783.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fiona Reid Nicholas Hart Louise Rose John Smith Clare Harris Victoria Cornelius Gerrard Francis Rafferty Daniel Hadfield Clare Finney Bethany Penhaligon Sian Saha Harriet Noble Philip Anthony Hopkins |
spellingShingle |
Fiona Reid Nicholas Hart Louise Rose John Smith Clare Harris Victoria Cornelius Gerrard Francis Rafferty Daniel Hadfield Clare Finney Bethany Penhaligon Sian Saha Harriet Noble Philip Anthony Hopkins Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey BMJ Open Respiratory Research |
author_facet |
Fiona Reid Nicholas Hart Louise Rose John Smith Clare Harris Victoria Cornelius Gerrard Francis Rafferty Daniel Hadfield Clare Finney Bethany Penhaligon Sian Saha Harriet Noble Philip Anthony Hopkins |
author_sort |
Fiona Reid |
title |
Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey |
title_short |
Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey |
title_full |
Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey |
title_fullStr |
Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey |
title_full_unstemmed |
Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey |
title_sort |
factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey |
publisher |
BMJ Publishing Group |
series |
BMJ Open Respiratory Research |
issn |
2052-4439 |
publishDate |
2020-05-01 |
description |
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. |
url |
https://bmjopenrespres.bmj.com/content/7/1/e000783.full |
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