Non-invasive Neurally Adjusted Ventilatory Assist

Non-invasive Neurally Adjusted Ventilatory Assist (niNAVA) After Extubation: Proposal for a Crossover-randomized Feasibility Trial

Neurally adjusted ventilatory assist (NAVA) is a new concept of mechanical ventilation. NAVA delivers assistance to spontaneous breathing based on the detection of the electrical activity of the diaphragm. The investigators will study the effects of non-invasive NAVA on respiratory muscle unloading critically ill patients.

To assess the effects of non-invasive NAVA on respiratory muscle unloading in critically ill patients

Inclusion Criteria:

• Age 18 - 85 years
• History of chronic obstructive lung disease
• Invasive mechanical ventilation for more than 12 hours
• Planned extubation according to the weaning protocol of our clinic
• Informed consent obtained from a next of kin
• Enrollment approval from a neutral physician neither participating in the study nor in the clinical treatment of the patient

Exclusion Criteria:

• Tracheostomy
• Facial or cranial trauma or surgery
• Oral, esophageal, diaphragmatic or gastric trauma or surgery
• Contraindication to insertion of a nasogastric tube (e. g. malformation, esophageal varices, esophageal perforation or rupture, Zenkers diverticulum, severe bleeding disorder)
• Uncooperative state and combativeness not responding to low levels of sedatives
• Neurological disease possibly influencing the brainstem respiratory centre, such as but not limited to: intracerebral, subarachnoidal or subdural hemorrhage, cerebral infarction, possible hypoxic encephalopathy
• Next of kin refuses informed consent
• Pregnancy. In female patients between 18 and 60 years of age, a pregnancy test will be performed.