Dallas, TX – Patients at Parkland can breathe easier – quite literally. A new technology in mechanical ventilation listens to a patient’s body to better monitor their breathing and to determine how to help them breathe easier.
Called Neurally Adjusted Ventilatory Assist, or NAVA, the new ventilators work with a specialized nasal/oral gastric tube, which senses the electrical pulses sent from the brain to the diaphragm. These sensors allow the ventilator to deliver pressure proportionally to the amount of diaphragmatic activity it measures. This helps Parkland’s Respiratory Therapy and physician staff to adjust the ventilator to facilitate breathing for the patient according to each person’s unique body demands.
“NAVA patterns a more normal breathing pattern. It’s closer to breathing neurologically for the patient. Basically, it better syncs the patient with the ventilator,” explains Ed Best, Director of Respiratory Care.
At the same time, the technology allows the Respiratory Therapy staff to monitor more closely the diaphragm’s activity. “It’s like another vital sign,” Best adds.
When working with patients on ventilators, Respiratory Therapists must strike a delicate balance, says Dean Holland, Respiratory Educator.
“When we make changes in the ventilator settings, we can see how a patient is responding. Is a patient working too hard? Are we giving the patient too much support with the ventilator? We don’t want them to work too much but we don’t want to give too much support,” Holland says. “NAVA gets closer to mimicking a normal breathing pattern so that while the patients are on the ventilator they feel more comfortable.”
Healing the patient
Patient quality of life has as much to do with healing as medical technology and science. Taking a patient off a ventilator is about more than removing a machine.
“Our number one goal is to get the patient off the ventilator,” Best says. “It affects quality of life. The longer a patient is on a ventilator, the more risks for complications are present, like ventilator associated pneumonia.
“You’re also giving people their independence back while they’re in the hospital. They’re able to talk with family and staff. It helps emotionally when patients are able to communicate and participate in their own health care. It means they’re getting well. Two days less on a ventilator means a lot in quality of care.”
Decreasing the amount of time a patient is on a ventilator is important because patients on a ventilator are at increased risk for pneumonia and injury related to lungs and airways.
In October 2011, at the Clinical Safety and Effectiveness conference, Parkland’s Respiratory Therapy department received an award for the second best “outstanding patient safety and quality improvement project.” The project demonstrated a decrease of 2.1 ventilator days in the Parkland Medicine Intensive Care Unit (MICU). In addition, ventilator-associated pneumonia decreased by 32 percent house-wide compared to the previous fiscal year. This means 30 fewer ventilator patients developed the complication.
The team achieved these results partly by implementing what are called spontaneous breathing trials on indicated patients every day. That means, in collaboration with Nursing, sedation was stopped and patients were allowed to try to breathe on their own.
“We decreased the duration of ventilator days in one of the ICUs by two days during a four-month period,” Best says. “We saw how we could start getting patients off the ventilator faster as it is medically appropriate. We have now developed and implemented a universal weaning protocol in all adult ICUs.”
The new NAVA technology helps Parkland continue its goal of reducing the number of days patients spend on ventilators by improving the monitoring of those patients and avoiding additional sedation.
“Prior to this technology, we had to rely on external indicators to tell us how well we were helping patients breathe on the ventilator. Because intubated patients are unable to communicate, it is difficult to interpret physiological changes we see on our monitors,” says Christian Minshall, MD, Parkland physician and Assistant Professor of Surgery at UT Southwestern Medical Center.
“Patients with rapid breathing, rapid heart rate or agitation are frequently treated with sedating medications, which may actually compound their respiratory failure. The NAVA technology gives another piece of information to help us determine if these responses are because we need to modify the ventilator support or if the symptoms are from another cause,” he says.
Many patients stand to benefit from the NAVA technology. Parkland has 65 ventilators. At any one time 35 to 40 adult ventilators and 10 to 20 in the nurseries are in use.
Currently, NAVA technology is available on 15 ventilators. Parkland began using the technology in November and it will continue to be rolled out over the next few years as more personnel are trained to use the technology and more data is gathered on its effectiveness.
“This highlights one area of Respiratory Therapy’s collaboration with Nursing and physicians,” Best adds. “Our standard of care is enhanced with NAVA and greatly benefits our patients.” Continue>