The main benefit observed in our cases was an improvement in oxygenation associated with a normalization of blood pH. This was achieved with marked decrease in peak airway pressure. This effect has been previously found in crossover studies reporting NAVA in weaning children from a respirator who were operated on for congenital heart disease and comparing NAVA with pressure support [1] [2] [3] . Clinically, breathing becomes easier with harmonious chest movements. In one of our cases, NAVA was very effective for ventilation in a child who had both ARDS and extensive cutaneous emphysema. The excellent synchronization of mechanical ventilation with the spontaneous breathing of the child improved oxygenation without aggravating the emphysema.