{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:47:19Z","timestamp":1787845639685,"version":"build-2784847793"},"reference-count":121,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Maintaining spontaneous breathing has both potentially beneficial and deleterious consequences in patients with acute respiratory failure, depending on the balance that can be obtained between the protecting and damaging effects on the lungs and the diaphragm. Neurally adjusted ventilatory assist (NAVA) is an assist mode, which supplies the respiratory system with a pressure proportional to the integral of the electrical activity of the diaphragm. This proportional mode of ventilation has the theoretical potential to deliver lung- and respiratory-muscle-protective ventilation by preserving the physiologic defense mechanisms against both lung overdistention and ventilator overassistance, as well as reducing the incidence of diaphragm disuse atrophy while maintaining patient\u2013ventilator synchrony. This narrative review presents an overview of NAVA technology, its basic principles, the different methods to set the assist level and the findings of experimental and clinical studies which focused on lung and diaphragm protection, machine\u2013patient interaction and preservation of breathing pattern variability. A summary of the findings of the available clinical trials which investigate the use of NAVA in acute respiratory failure will also be presented and discussed.<\/jats:p>","DOI":"10.3390\/jcm11071863","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T21:44:52Z","timestamp":1648590292000},"page":"1863","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Neurally Adjusted Ventilatory Assist in Acute Respiratory Failure\u2014A Narrative Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4356-3543","authenticated-orcid":false,"given":"Michele","family":"Umbrello","sequence":"first","affiliation":[{"name":"SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo\u2014Polo Universitario, Via Pio II, 3, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Antonucci","sequence":"additional","affiliation":[{"name":"SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo\u2014Polo Universitario, Via Pio II, 3, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Muttini","sequence":"additional","affiliation":[{"name":"SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo\u2014Polo Universitario, Via Pio II, 3, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/atm.2017.06.55","article-title":"Spontaneous breathing: A double-edged sword to handle with care","volume":"5","author":"Mauri","year":"2017","journal-title":"Ann. Transl. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1164\/ajrccm.159.4.9806077","article-title":"Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome","volume":"159","author":"Putensen","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.1513\/AnnalsATS.201704-339FR","article-title":"Cardiopulmonary interactions: Physiologic basis and clinical applications","volume":"15","author":"Pinsky","year":"2018","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/MCC.0000000000000597","article-title":"Impact of spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome","volume":"25","author":"Yoshida","year":"2019","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1164\/rccm.202003-0655CP","article-title":"Lung and Diaphragm-Protective Ventilation","volume":"202","author":"Dres","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1164\/rccm.201605-1081CP","article-title":"Mechanical ventilation to minimize progression of pulmonary lung injury in acute respiratory failure","volume":"195","author":"Brochard","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e678","DOI":"10.1097\/CCM.0000000000001649","article-title":"Spontaneous effort during mechanical ventilation: Maximal injury with less positive end-expiratory pressure","volume":"44","author":"Yoshida","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00134-015-3692-6","article-title":"Asynchronies during mechanical ventilation are associated with mortality","volume":"41","author":"Blanch","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-016-1290-9","article-title":"Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study","volume":"20","author":"Bellani","year":"2016","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/S2213-2600(18)30366-7","article-title":"Diaphragmatic myotrauma: A mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure","volume":"7","author":"Goligher","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1056\/NEJMoa1005372","article-title":"Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome","volume":"363","author":"Papazian","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1007\/s00134-020-06206-z","article-title":"Proportional modes of ventilation: Technology to assist physiology","volume":"46","author":"Jonkman","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_13","first-page":"2126","article-title":"Ventilator-Induced Lung Injury","volume":"369","author":"Slutsky","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.23736\/S0375-9393.19.13418-9","article-title":"Patient self-inflicted lung injury: Implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support","volume":"85","author":"Grieco","year":"2019","journal-title":"Minerva Anestesiol"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1097\/CCM.0b013e3182451c40","article-title":"Spontaneous breathing during lung-protective ventilation in an experimental acute lung injury model: High transpulmonary pressure associated with strong spontaneous breathing effort may worsen lung injury","volume":"40","author":"Yoshida","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1152\/jappl.1970.28.5.596","article-title":"Stress distribution in lungs: A model of elasticity","volume":"28","author":"Mead","year":"1970","journal-title":"Am. J. Appl. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1164\/rccm.201303-0539OC","article-title":"Spontaneous effort causes occult pendelluft during mechanical ventilation","volume":"188","author":"Yoshida","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.chest.2016.03.043","article-title":"Negative Pressure Pulmonary Edema","volume":"150","author":"Bhattacharya","year":"2016","journal-title":"Chest"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1164\/rccm.201604-0748CP","article-title":"Spontaneous breathing during mechanical ventilation-mechanisms, risks and management","volume":"195","author":"Yoshida","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/MCC.0b013e328011278d","article-title":"Modulation and treatment of patient\u2013ventilator dyssynchrony","volume":"13","author":"Kondili","year":"2007","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/ALN.0000000000000694","article-title":"Assisted Ventilation in Patients with Acute Respiratory","volume":"123","author":"Doorduin","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_22","first-page":"2740","article-title":"Ineffective triggering predicts increased duration of mechanical ventilation","volume":"37","author":"Miller","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1007\/s00134-006-0301-8","article-title":"Patient-ventilator asynchrony during assisted mechanical ventilation","volume":"32","author":"Thille","year":"2006","journal-title":"Intensive Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s00134-008-1121-9","article-title":"Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation","volume":"34","author":"Thille","year":"2008","journal-title":"Intensive Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1378\/chest.12-1817","article-title":"Mechanical ventilation-induced reverse-triggered breaths: A frequently unrecognized form of neuromechanical coupling","volume":"143","author":"Akoumianaki","year":"2013","journal-title":"Chest"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1164\/rccm.201610-1972OC","article-title":"Volume Controlled Ventilation Does Not Prevent Injurious Inflation During Spontaneous Effort","volume":"196","author":"Yoshida","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jcrc.2008.08.011","article-title":"Observational study of patient-ventilator asynchrony and relationship to sedation level","volume":"24","author":"Pedram","year":"2009","journal-title":"J. Crit. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1007\/s00134-011-2433-8","article-title":"Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients","volume":"38","author":"Patroniti","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1164\/ajrccm.162.2.9901024","article-title":"Assessment of neural inspiratory time in ventilator-supported patients","volume":"162","author":"Parthasarathy","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.4187\/respcare.07284","article-title":"Patient-ventilator asynchronies: Clinical implications and practical solutions","volume":"65","author":"Mirabella","year":"2020","journal-title":"Respir. Care"},{"key":"ref_31","first-page":"21","article-title":"Monitoring Patient Respiratory Effort During Mechanical Ventilation: Lung and Diaphragm-Protective Ventilation","volume":"2020","author":"Bertoni","year":"2020","journal-title":"Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1007\/s00134-017-4928-4","article-title":"Critical illness-associated diaphragm weakness","volume":"43","author":"Dres","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1183\/09031936.05.00105204","article-title":"Granulocytosis and increased adhesion molecules after resistive loading of the diaphragm","volume":"26","author":"Wang","year":"2005","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1164\/ajrccm.162.5.9906033","article-title":"Time course of diaphragm injury and calpain activity during resistive loading","volume":"162","author":"Reid","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1164\/ajrccm.157.1.9702051","article-title":"Load dependence of secondary diaphragm inflammation and injury after acute inspiratory loading","volume":"157","author":"Jiang","year":"1998","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1056\/NEJMoa070447","article-title":"Rapid Disuse Atrophy of Diaphragm Fibers in Mechanically Ventilated Humans","volume":"358","author":"Levine","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1164\/rccm.201503-0620OC","article-title":"Evolution of Diaphragm Thickness During Mechanical Ventilation: Impact of Inspiratory Effort","volume":"192","author":"Goligher","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1164\/rccm.201605-0992OC","article-title":"The diaphragm acts as a brake during expiration to prevent lung collapse Mariangela Pellegrini","volume":"195","author":"Pellegrini","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_39","first-page":"1","article-title":"Positive End-expiratory Pressure Ventilation Induces Longitudinal Atrophy in Diaphragm Fibers. American Journal of Respiratory and Critical Care Medicine","volume":"120947","author":"Lindqvist","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1007\/s00134-017-4896-8","article-title":"The intensive care medicine research agenda for airways, invasive and noninvasive mechanical ventilation","volume":"43","author":"Jaber","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Rauseo, M., and Piquilloud, L. (2019). Proportional modes. ERS Practical Handbook of Invasive Mechanical Ventilation, The European Respiratory Society.","DOI":"10.1183\/9781849841221.028518"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1164\/ajrccm\/145.1.114","article-title":"Proportional Assist Ventilation, a New Approach to Ventilatory Support","volume":"145","author":"Younes","year":"1992","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_43","first-page":"249","article-title":"New modes of assisted ventilation","volume":"38","year":"2014","journal-title":"Med. Intensiva."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"140","DOI":"10.4187\/respcare.01021","article-title":"Proportional assist ventilation and neurally adjusted ventilatory assist","volume":"56","author":"Kacmarek","year":"2011","journal-title":"Respir. Care"},{"key":"ref_45","first-page":"619","article-title":"Respiratory response to CO2 during pressure-support ventilation conscious normal humans","volume":"6","author":"Georgopoulos","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1164\/ajrccm.155.6.9196108","article-title":"Effects of inspiratory muscle unloading on the response of respiratory motor output to CO2","volume":"155","author":"Georgopoulos","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1034\/j.1399-3003.1999.13d30.x","article-title":"Effects of chemical feedback on respiratory motor and ventilatory output during different modes of assisted mechanical ventilation","volume":"13","author":"Mitrouska","year":"1999","journal-title":"Eur. Respir. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1007\/s00134-020-05942-6","article-title":"Respiratory drive in the acute respiratory distress syndrome: Pathophysiology, monitoring, and therapeutic interventions","volume":"46","author":"Spinelli","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1007\/s00134-013-2850-y","article-title":"Patient-ventilator synchrony and sleep quality with proportional assist and pressure support ventilation","volume":"39","author":"Alexopoulou","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1007\/s00134-009-1524-2","article-title":"Is proportional-assist ventilation with load-adjustable gain factors a user-friendly mode?","volume":"35","author":"Xirouchaki","year":"2009","journal-title":"Intensive Care Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1097\/CCM.0b013e3181ee355d","article-title":"The Hering-Breuer reflex, feedback control, and mechanical ventilation: The promise of neurally adjusted ventilatory assist","volume":"38","author":"Leiter","year":"2010","journal-title":"Crit. Care Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1378\/chest.06-1909","article-title":"Inspiratory muscle unloading by neurally adjucted ventilatory assist during maximal inspiratory efforts in healthy subjects","volume":"131","author":"Sinderby","year":"2007","journal-title":"Chest"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1097\/ALN.0000000000000432","article-title":"Increased diaphragmatic contribution to inspiratory effort during neurally adjusted ventilatory assistance versus pressure support: An electromyographic study","volume":"121","author":"Cecchini","year":"2014","journal-title":"Anesthesiology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13613-018-0470-y","article-title":"Proportional modes versus pressure support ventilation: A systematic review and meta-analysis","volume":"8","author":"Kataoka","year":"2018","journal-title":"Ann. Intensive Care"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1038\/71012","article-title":"Neural control of mechanical ventilation in respiratory failure","volume":"5","author":"Sinderby","year":"1999","journal-title":"Nat. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1164\/ajrccm.163.4.2005063","article-title":"A Method for Noninvasive Determination of Inspiratory Resistance during Proportional Assist Ventilation","volume":"163","author":"Younes","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1164\/ajrccm.164.1.2010068","article-title":"A method for measuring passive elastance during proportional assist ventilation","volume":"164","author":"Younes","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1152\/jappl.1997.82.4.1370","article-title":"Enhancement of signal quality in esophageal recordings of diaphragm EMG","volume":"82","author":"Sinderby","year":"1997","journal-title":"Am. J. Appl. Physiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1007\/s00134-009-1587-0","article-title":"Evaluation of the catheter positioning for neurally adjusted ventilatory assist","volume":"35","author":"Barwing","year":"2009","journal-title":"Intensive Care Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1164\/ajrccm.164.3.2009018","article-title":"Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure","volume":"164","author":"Beck","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.bja.2021.03.010","article-title":"Pulmonary volume-feedback and ventilatory pattern after bilateral lung transplantation using neurally adjusted ventilatory assist ventilation","volume":"127","author":"Grasselli","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jcrc.2014.08.013","article-title":"Relation between peak and integral of the diaphragm electromyographic activity at different levels of support during weaning from mechanical ventilation: A physiologic study","volume":"30","author":"Muttini","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1152\/jappl.1996.81.3.1434","article-title":"Influence of bipolar esophageal electrode positioning on measurements of human crural diaphragm electromyogram","volume":"81","author":"Beck","year":"1996","journal-title":"J. Appl. Physiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1378\/chest.08-1747","article-title":"Titration and implementation of neurally adjusted ventilatory assist in critically III patients","volume":"135","author":"Brander","year":"2009","journal-title":"Chest"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/014860717900300310","article-title":"Predictive Criteria for Length of Nasogastric Tube Insertion for Tube Feeding","volume":"3","author":"Hanson","year":"1979","journal-title":"J. Parenter Enter Nutr."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1152\/jappl.1971.30.6.797","article-title":"Mechanics of the diaphragm","volume":"30","author":"Pengelly","year":"1971","journal-title":"J. Appl. Physiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1007\/s00134-011-2373-3","article-title":"Influence of body position, PEEP and intra-abdominal pressure on the catheter positioning for neurally adjusted ventilatory assist","volume":"37","author":"Barwing","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.resp.2014.01.021","article-title":"Physiological comparison of breathing patterns with neurally adjusted ventilatory assist (NAVA) and pressure-support ventilation to improve NAVA settings","volume":"195","author":"Meric","year":"2014","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1152\/jappl.1998.85.3.1123","article-title":"Effects of lung volume on diaphragm EMG signal strength during voluntary contractions","volume":"85","author":"Beck","year":"1998","journal-title":"J. Appl. Physiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.1152\/jappl.1998.85.6.2146","article-title":"Voluntary activation of the human diaphragm in health and disease","volume":"85","author":"Sinderby","year":"1998","journal-title":"J. Appl. Physiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1183\/09031936.00093408","article-title":"Neural respiratory drive in healthy subjects and in COPD","volume":"33","author":"Jolley","year":"2009","journal-title":"Eur. Respir. J."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13613-019-0564-1","article-title":"Information conveyed by electrical diaphragmatic activity during unstressed, stressed and assisted spontaneous breathing: A physiological study","volume":"9","author":"Piquilloud","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1007\/s00134-012-2588-y","article-title":"Assessment of patient-ventilator breath contribution during neurally adjusted ventilatory assist","volume":"38","author":"Grasselli","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1093\/bja\/aet258","article-title":"Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist","volume":"111","author":"Repusseau","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1097\/CCM.0b013e31827caba0","article-title":"Estimation of patient\u2019s inspiratory effort from the electrical activity of the diaphragm","volume":"41","author":"Bellani","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-018-2172-0","article-title":"Estimation of the diaphragm neuromuscular efficiency index in mechanically ventilated critically ill patients","volume":"22","author":"Jansen","year":"2018","journal-title":"Crit. Care"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1097\/ALN.0b013e3181ee2ef1","article-title":"Neurally adjusted ventilatory assist in critically ill postoperative patients: A crossover randomized study","volume":"113","author":"Coisel","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.resp.2009.02.015","article-title":"Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA)","volume":"166","author":"Lecomte","year":"2009","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/CCM.0000000000001418","article-title":"Comparison between Neurally Adjusted Ventilatory Assist and Pressure Support Ventilation Levels in Terms of Respiratory Effort","volume":"44","author":"Carteaux","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s00134-011-2209-1","article-title":"Daily titration of neurally adjusted ventilatory assist using the diaphragm electrical activity","volume":"37","author":"Lafrikh","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1007\/s00134-020-06181-5","article-title":"Neurally adjusted ventilatory assist in acute respiratory failure: A randomized controlled trial","volume":"46","author":"Kacmarek","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/ALN.0000000000002335","article-title":"Standardized unloading of respiratory muscles during neurally adjusted ventilatory assist: A randomized crossover pilot study","volume":"129","author":"Jalde","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s00134-013-2898-8","article-title":"Ventilation distribution measured with EIT at varying levels of pressure support and Neurally Adjusted Ventilatory Assist in patients with ALI","volume":"39","author":"Blankman","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fphys.2019.01392","article-title":"The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment\u2013Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome","volume":"10","author":"Widing","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1007\/s00134-009-1626-x","article-title":"Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury","volume":"35","author":"Brander","year":"2009","journal-title":"Intensive Care Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00134-018-5311-9","article-title":"Plateau and driving pressure in the presence of spontaneous breathing","volume":"45","author":"Bellani","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1164\/rccm.201902-0454LE","article-title":"Assessment of airway driving pressure and respiratory system mechanics during neurally adjusted ventilatory assist","volume":"200","author":"Grasselli","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1007\/s00134-016-4400-x","article-title":"Esophageal and transpulmonary pressure in the clinical setting: Meaning, usefulness and perspectives","volume":"42","author":"Mauri","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13613-017-0289-y","article-title":"Can proportional ventilation modes facilitate exercise in critically ill patients? A physiological cross-over study: Pressure support versus proportional ventilation during lower limb exercise in ventilated critically ill patients","volume":"7","author":"Akoumianaki","year":"2017","journal-title":"Ann. Intensive Care"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2997","DOI":"10.1097\/01.CCM.0000242520.50665.9F","article-title":"Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury","volume":"34","author":"Allo","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12931-019-1265-x","article-title":"Neurally adjusted ventilatory assist mitigates ventilator-induced diaphragm injury in rabbits","volume":"20","author":"Shimatani","year":"2019","journal-title":"Respir. Res."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/EJA.0000000000001261","article-title":"Comparative effects of neurally adjusted ventilatory assist and variable pressure support on lung and diaphragmatic function in a model of acute respiratory distress syndrome: A randomised animal study","volume":"38","author":"Scharffenberg","year":"2021","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-021-03644-z","article-title":"Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: A systematic review and meta-analysis","volume":"25","author":"Yuan","year":"2021","journal-title":"Crit. Care"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1007\/s00134-016-4447-8","article-title":"Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: A French multicentre randomized trial","volume":"42","author":"Demoule","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1097\/ALN.0000000000003207","article-title":"Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation in Difficult Weaning","volume":"132","author":"Liu","year":"2020","journal-title":"Anesthesiology"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1164\/rccm.201703-0536OC","article-title":"Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes","volume":"197","author":"Goligher","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-015-1178-0","article-title":"Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV","volume":"20","author":"Spadaro","year":"2016","journal-title":"Crit. Care"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1164\/ajrccm.155.4.9105077","article-title":"Effect of elastic loading on variational activity of breathing","volume":"155","author":"Brack","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1164\/ajrccm.157.6.9704114","article-title":"Effect of resistive loading on variational activity of breathing","volume":"157 Pt 1","author":"Brack","year":"1998","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-015-0763-6","article-title":"Neurally adjusted ventilatory assist and proportional assist ventilation both improve patient-ventilator interaction","volume":"19","author":"Schmidt","year":"2015","journal-title":"Crit. Care"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1097\/CCM.0b013e3181cb0d7b","article-title":"Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist","volume":"38","author":"Spahija","year":"2010","journal-title":"Crit. Care Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1203\/01.pdr.0000257324.22406.93","article-title":"Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits","volume":"61","author":"Beck","year":"2007","journal-title":"Pediatr. Res."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/s00134-007-0882-x","article-title":"Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury","volume":"34","author":"Beck","year":"2008","journal-title":"Intensive Care Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s00134-010-2052-9","article-title":"Neurally adjusted ventilatory assist improves patient-ventilator interaction","volume":"37","author":"Piquilloud","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Yonis, H., Crognier, L., Conil, J.M., Serres, I., Rouget, A., Virtos, M., Cougot, P., Minville, V., Fourcade, O., and Georges, B. (2015). Patient-ventilator synchrony in Neurally Adjusted Ventilatory Assist (NAVA) and Pressure Support Ventilation (PSV): A prospective observational study. BMC Anesthesiol., 15.","DOI":"10.1186\/s12871-015-0091-z"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-018-2288-2","article-title":"Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation: Patient-ventilator interaction during invasive ventilation delivered by tracheostomy","volume":"23","author":"Lamouret","year":"2019","journal-title":"Crit. Care"},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Ferreira, J.C., Diniz-silva, F., Moriya, H.T., Alencar, A.M., Amato, M.B.P., and Carvalho, C.R.R. (2017). Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: A crossover trial. BMC Pulm. Med., 17.","DOI":"10.1186\/s12890-017-0484-5"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.resp.2014.08.012","article-title":"Physiologic comparison of neurally adjusted ventilator assist, proportional assist and pressure support ventilation in critically ill patients","volume":"203","author":"Akoumianaki","year":"2014","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-020-02923-5","article-title":"Neurally adjusted ventilatory assist versus pressure support ventilation: A randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation","volume":"24","author":"Hadfield","year":"2020","journal-title":"Crit. Care"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"945","DOI":"10.2147\/COPD.S103213","article-title":"A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation","volume":"11","author":"Kuo","year":"2016","journal-title":"Int. J. COPD."},{"key":"ref_111","first-page":"1","article-title":"Neurally adjusted ventilatory assist vs. pressure support to deliver protective mechanical ventilation in patients with acute respiratory distress syndrome: A randomized crossover trial","volume":"10","author":"Moriya","year":"2020","journal-title":"Ann. Intensive Care"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"e000783","DOI":"10.1136\/bmjresp-2020-000783","article-title":"Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: A clinician survey","volume":"7","author":"Hadfield","year":"2020","journal-title":"BMJ Open Respir. Res."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1097\/00000542-200112000-00010","article-title":"Adaptive Support Ventilation for Fast Tracheal Extubation after Cardiac Surgery","volume":"95","author":"Sulzer","year":"2001","journal-title":"Anesthesiology"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1164\/rccm.200511-1780OC","article-title":"A Multicenter Randomized Trial of Computer-driven Protocolized Weaning from Mechanical Ventilation","volume":"174","author":"Lellouche","year":"2006","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1213\/ane.0b013e318190c49f","article-title":"Weaning Automation with Adaptive Support Ventilation: A Randomized Controlled Trial in Cardiothoracic Surgery Patients","volume":"108","author":"Dongelmans","year":"2009","journal-title":"Anesth. Analg."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1164\/rccm.201206-1026OC","article-title":"Wean Earlier and Automatically with New Technology (the WEAN Study). A Multicenter, Pilot Randomized Controlled Trial","volume":"187","author":"Burns","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"327","DOI":"10.4187\/respcare.00775","article-title":"Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?","volume":"56","author":"Verbrugghe","year":"2011","journal-title":"Respir. Care"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1097\/00003246-200005000-00002","article-title":"Pressure support ventilation in patients with acute lung injury","volume":"28","author":"Cereda","year":"2000","journal-title":"Crit. Care Med."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1007\/s00134-008-1208-3","article-title":"Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure","volume":"34","author":"Colombo","year":"2008","journal-title":"Intensive Care Med."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1097\/CCM.0b013e3181eb3c51","article-title":"Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: Physiological evaluation","volume":"38","author":"Terzi","year":"2010","journal-title":"Crit. Care Med."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"382","DOI":"10.21037\/atm.2019.07.60","article-title":"Neurally adjusted ventilatory assist versus pressure support ventilation in patient-ventilator interaction and clinical outcomes: A meta-analysis of clinical trials","volume":"7","author":"Chen","year":"2019","journal-title":"Ann. Transl. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1863\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:44:36Z","timestamp":1760136276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1863"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,28]]},"references-count":121,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jcm11071863"],"URL":"https:\/\/doi.org\/10.3390\/jcm11071863","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,28]]}}}