Servo-n with Neurally Adjusted Ventilatory Assist (NAVA) for babies and children

The technology described in this briefing is the Servo‑n with Neurally Adjusted Ventilatory Assist (NAVA). It is used for babies and children up to 30 kg who need mechanical ventilation.

The innovative aspects are that NAVA detects and uses electrical changes in the diaphragm muscle to detect the patient's respiratory drive with the aim of synchronising ventilation. Synchronisation reduces the risk of damage to young or diseased lungs from assisted ventilation.

The intended place in therapy would be for mechanical ventilation in neonatal and paediatric intensive care units. The optimum place in therapy is uncertain.

The main points from the evidence summarised in this briefing are from 4 studies, including 2 randomised controlled crossover trials, 1 randomised controlled trial (RCT) and 1 systematic review involving a total of 415 babies and children in paediatric and neonatal intensive care units. The systematic review and 1 RCT showed that Servo‑n with NAVA improved patient-ventilator synchrony.

Key uncertainties around the technology are that the evidence base is still developing and that it is unclear which patient groups are most likely to benefit.

The cost of a Servo‑n ventilator is £28,000 per unit. A NAVA module that has a list price of around £6,300 (both exclusive of VAT) is also needed. The single-use NAVA catheter, which incorporates a feeding tube, costs £145. The resource impact for the NHS would be greater than standard care. This may be offset by more intensive care capacity being released if the evidence supports improved outcomes.