Diaphragm electrical activity target during NAVA: One size may not fit all

Sindelar and colleagues in their recent article entitled "Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants" provides succinct clinical guidance for the initiation and adjustment of NAVA parameters. We would like to provide a note of caution on the proposed target (between 5 and 10-15 μV) of electrical activity of the diaphragm (EAdi) when setting NAVA level. A single target may not be appropriate in all patients, and an adaptation to the patient condition may be necessary especially in infants with neuromuscular disorders or severe lung disease. The EAdi target in these patients should be individualized, considering that excessive support may result in overassistance, prolonged mechanical ventilation and duration of stay. This article is protected by copyright. All rights reserved.