Network meta-analysis suggests NAVA may improve liberation from invasive ventilation

A systematic review and network meta-analysis published in Critical Care evaluated advanced assisted ventilation modes for adults undergoing weaning from invasive mechanical ventilation in the ICU. Researchers searched three databases through March 27, 2026, including 23 randomized controlled trials involving 3,755 patients. The primary outcome was weaning success; secondary outcomes included ventilation duration, patient–ventilator asynchrony, reintubation and mortality.

Compared with pressure support ventilation (PSV), neurally adjusted ventilatory assist (NAVA) increased weaning success (risk ratio 1.13, 95% CI 1.00–1.27) and shortened weaning by 0.58 days (95% CI 0.18–0.99 days). NAVA also reduced asynchrony and was associated with lower hospital mortality (risk ratio 0.59, 95% CI 0.40–0.86), shorter invasive ventilation duration and more ventilator-free days. Adaptive support ventilation shortened weaning by 0.65 days (95% CI 0.24–1.06 days). Other modes did not significantly improve weaning success, and no significant differences were observed in reintubation, ICU mortality or 28-day mortality.

The findings suggest potential benefits from NAVA, particularly where asynchrony complicates weaning. However, its weaning-success estimate borders the null, and the hospital mortality finding was not accompanied by significant differences at other mortality endpoints. Although the authors assessed evidence certainty using CINeMA, the supplied text does not report those ratings, limiting interpretation of how strongly the results support changing routine practice.