Implementation of Neurally Adjusted Ventilatory Assist (NAVA): Patient characteristics and staff experiences.

OBJECTIVE: The objective of the study was to describe the implementation of Neurally Adjusted Ventilatory Assist (NAVA) by characteristics of patients receiving NAVA and by staff-experienced opportunities and barriers. METHODS: Design. A retrospective review of hospital records of mechanically ventilated patients over two time periods after implementation, as well as a questionnaire survey and interviews with staff. SETTING: A secondary Danish ICU. PARTICIPANTS: ICU patients, nurses, and intensivists. INTERVENTION: Implementation of NAVA, which included theoretical education, bedside training, and frequent updates. MAIN OUTCOME MEASURE: Evaluation of NAVA implementation measured by characteristics of patients receiving NAVA and staff experiences with NAVA. RESULTS: A total of 311 patients were included. Hereof 43 (27%) and 68 (44%) patients, respectively, had recieved NAVA. The patients receiving NAVA had higher severity scores and more hours on ventilators. A total of 35 nurses (76%) and 16 physicians (64%) completed the questionnaire. Most clinicians found, to a high (43%) or very high (41%) degree, that NAVA was an effective therapy option. Furthermore, 77% did not experience any barriers regarding NAVA therapy. The main advantages experienced with NAVA were increased patient comfort, respiratory synchrony with the ventilator, and improved opportunities for monitoring patient respiratory performance. The main disadvantage was the need for additional theoretical and practical knowledge. CONCLUSION: Despite staff experience of NAVA as a beneficial treatment option, more than half of the patients did not receive NAVA treatment two years after the start of its implementation. Implementation of a therapy which is substantially different to earlier practices is complicated.

[Poisoning with aluminum phospholipide used as a poison against moles]. / Forgiftning med muldvarpegasningsmidlet aluminiumfosfid.

Aluminium phosphide (AIP) is a poison used in Denmark to combat moles and vermines e.g. in granaries. On contact with water AIP releases phosphine gas, which has a strong cytotoxic action. We describe a lethal poisoning in a healthy 83 year old man, caused by ingestion of pellets containing AIP. After ingestion the primary symptoms were burning retrosternal pain, severe vomiting and diarrhoea which progressed to cardiac failure, arrhythmias and severe metabolic acidosis. The patient and his excreta smelled of garlic, ammonium carbide and decaying fish, which is characteristic of this poisoning. In spite of intensive care support the patient died in cardiac and respiratory failure 17 hours after ingestion of the pellets. Treatment is supportive. Knowledge about the toxicity of AIP is described and discussed.