Advice
Specialist commentator comments
Specialist commentator comments
Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
All 5 specialists were familiar with this technology. One specialist is currently using it in their paediatric intensive care unit (PICU) and 1 specialist was involved in a clinical test of the Servo‑n on their ward.
Potential patient impact
One specialist thought that use of NAVA could potentially reduce the use of sedative drugs. Another specialist mentioned it could potentially reduce lung injury in babies because an endotracheal tube would not need to be used. They said that this could particularly benefit pre-term babies (23 to 25 weeks' gestation). One specialist noted that a small subset of patients may achieve better synchronisation with NAVA than with other methods of detecting a patient's efforts to breathe.
Potential system impact
Two specialists thought that NAVA had the potential to reduce the number of ventilator days. Two specialists said that NAVA is likely to cost more than conventional ventilators. Another specialist noted that the upfront cost of NAVA is more but if NAVA was able to reduce the length of stay in a PICU, then this could lead to an overall saving. One specialist highlighted that if NAVA was adopted, existing feeding tubes would need to be changed to a NAVA catheter and these are currently substantially more expensive. Two other specialists noted that the cost of the catheters might be a barrier to adoption. Another specialist thought that a further barrier to adoption was that NAVA can only be used with Servo ventilators. All 5 specialists thought that NAVA would be used as an addition to current standard care but 1 said that if the technology was proven to have significant clinical benefit then it could replace it.
General comments
One specialist reported that after a 2 month trial of Servo‑n, their PICU has now invested in 16 ventilators. All of the specialists thought that more research with NAVA was needed. One specialist said that a cost benefit analysis, long-term outcome data and a comparison of time to discharge would be valuable. Another specialist suggested some key clinical outcomes for future research. These included: effectiveness in helping extubation, reducing the duration of ventilation and reducing length of hospital stay.