CoReCCT: Neurally Adjusted Ventilatory Assist (NAVA) compared to conventional ventilation for patients at risk of difficult or prolonged weaning from invasive mechanical ventilation

Every year, thousands of patients in UK intensive care units are kept alive by mechanical ventilators, but the breathing tube itself can cause harm the longer it stays in. This trial tests whether a smarter ventilator—one that reads the patient’s own electrical breathing signals from the diaphragm—can get them off the machine faster than standard care. The problem is straightforward: prolonged ventilation raises the risk of pneumonia, muscle wasting, and longer hospital stays. Current ventilators push air in on a fixed schedule, which often fights against a patient’s own breathing efforts. The new approach, called Neurally Adjusted Ventilatory Assist (NAVA), uses a small sensor on a feeding tube to detect when the diaphragm fires, then synchronises the machine’s breath with the patient’s natural rhythm. If NAVA works, it could shorten time on the ventilator for the sickest patients—those with COPD, heart failure, pneumonia, or kidney injury—and reduce the number who need a tracheostomy. The trial will also calculate whether the technology saves the NHS money by cutting intensive care bed-days. This is a pragmatic, patient-focused trial with a clear endpoint: getting people breathing on their own, sooner.