Denise Wheatley , Krystal Young
Cite
Wheatley D, Young, K. Adaptive support ventilation. What is it? Beneficial or not? J Mech Vent 2020; 2(1):34-44.
Abstract
Ventilators functions and features have evolved with the advancement of technology along with the addition of microprocessors.
It is important to understand and examine the benefits and risks associated with these advanced automated modes.
Adaptive Support Ventilation (ASV) is a mode that is unique to the Hamilton Medical ventilators, thereby limiting the number of clinicians who have experience with using this mode. ASV can make changes to respiratory rate and tidal volume and adjusting the driving pressure in the absence of a professional. ASV changes ventilator strategies when it detects changes to a patient’s lung dynamics. The scope of ASV mode is not universally understood. Respiratory therapists may feel their position would be threatened with the use of smart automated modes.
This paper will aim to review the literature on the ASV mode of ventilation. The literature review will address the following research questions to broaden the understanding of the risks and benefits of the ASV mode. 1) Is the ASV mode effective
for weaning patients? 2) Is ASV a safe mode of ventilation for patients with COPD and ARDS? 3) Is ASV a safe mode of ventilation with changes in lung dynamics? 4) Does ASV impact the bedside respiratory therapist?
Conclusions: ASV appears to be at least effective or even more superior to other modes especially during weaning off mechanical ventilation, and in other forms of respiratory failure. More studies in different clinical conditions and head-to-head
with other modes.
Keywords
ASV, COPD, ARDS, Weaning
References
| 1. Fernández J, Miguelena D, Mulett, H, et al. Adaptive sup-port ventilation: State of the art review. Indian J Crit Care Med 2013; 17(1):16-22.2. https://doi.org/10.4103/0972-5229.112149 PMid:23833471 PMCid:PMC3701392 |
| 2. Hess D. Respiratory Mechanics in Mechanically Ventilated Patients. Respir Care 2014; 59(11):1773-1794. https://doi.org/10.4187/respcare.03410 PMid:25336536 |
| 3. Otis A. B., Fenn W. O., Rahn, H. Mechanics of breathing in man. J Appl Physiol 1950; 2:592-607. https://doi.org/10.1152/jappl.1950.2.11.592 PMid:15436363 |
| 4. Zhu F, Gomersall CD, Ng SK., et al. A randomized con-trolled trial of adaptive support ventilation mode to wean pa-tients after fast-track cardiac valvular surgery. Anesthesiolo-gy 2015; 122(4):832-840. https://doi.org/10.1097/ALN.0000000000000589 PMid:25569810 |
| 5. Aghadavoudi O, Kamran M., Masoudifar M. Comparison of two modes of ventilation after fast-track cardiac surgery: adaptive support ventilation versus synchronized intermittent mandatory ventilation. Pak J Med Sci 2012; 28(2):303-308. |
| 6. Yazdannik A, Zarei H, Massoumi G. Comparing the effects of adaptive support ventilation and synchronized intermittent mandatory ventilation on intubation duration and hospital stay after coronary artery bypass graft surgery. Iranian Jour-nal of Nursing and Midwifery Research Iran J Nurs Midwifery Res 2016; 21(2):207-212 https://doi.org/10.4103/1735-9066.178250 PMid:27095997 PMCid:PMC4815379 |
| 7. Tam MK, Wong WT, Gomersall, CD, et al. A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation. J Crit Care 2016; 33:163-168. https://doi.org/10.1016/j.jcrc.2016.01.018 PMid:27006266 |
| 8. Lellouche F, Bouchard P, Simard S, et al. Evaluation of fully automated ventilation: a randomized controlled study in post-cardiac surgery patients. Intensive Care Med 2013; 39(3): 463-471. https://doi.org/10.1007/s00134-012-2799-2 PMid:23338569 |
| 9. Gruber PC, Gomersall CD, Leung P,et al. Randomized con-trolled trial comparing adaptive-support ventilation with pres-sure-regulated volume-controlled ventilation with Automode in weaning patients after cardiac surgery. Anesthesiology 2008; 109(1): 81-87. https://doi.org/10.1097/ALN.0b013e31817881fc PMid:18580176 |
| 10. Fathi H M, Osman DM. Weaning of chronic obstructive pulmonary disease patients after coronary artery bypass graft surgery. Res Opin Anesth Intensive Care 2018; 5:147-153. https://doi.org/10.4103/roaic.roaic_55_17 |
| 11. De Bie AJR, Neto AS, van Meenen DM, Bouwman, et al. Fully automated postoperative ventilation in cardiac surgery patients: a randomized clinical trial. Br J Anaesth 2020; 125(5):739-749. https://doi.org/10.1016/j.bja.2020.06.037 PMid:32739044 |
| 12. Kirakli C, Ozdemir I, Ucar ZZ, et al. Adaptive support ven-tilation for faster weaning in COPD: A randomized controlled trial. Eur Respir J 2011; 38(4):774-780. https://doi.org/10.1183/09031936.00081510 PMid:21406514 |
| 13. Celli P, Privato E, Ianni S, et al. Adaptive support ventila-tion versus synchronized intermittent mandatory ventilation with pressure support in weaning patients after orthotopic liver transplantation. Transplant Proc 2014; 46(7):2272-2278. https://doi.org/10.1016/j.transproceed.2014.06.046 PMid:25150607 |
| 14. Rose L, Schultz MJ, Cardwell CR., et al. Automated versus non-automated weaning for reducing the duration of mechan-ical ventilation for critically ill adults and children: a cochrane systematic review and meta-analysis. Crit Care 2015; 19:48. https://doi.org/10.1186/s13054-015-0755-6 PMid:25887887 PMCid:PMC4344786 |
| 15. Kirakli C, Naz I, Ediboglu O, et al. A randomized con-trolled trial comparing the ventilation duration between adap-tive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest 2015; 147(6):1503-1509. https://doi.org/10.1378/chest.14-2599 PMid:25742308 |
| 16. Agarwal R, Srinivasan A, Aggarwal AN, et al. Adaptive support ventilation for complete ventilatory support in ARDS: A pilot randomized controlled trial. Respirology 2013; 18(7):1108-1115. https://doi.org/10.1111/resp.12126 PMid:23711230 |
| 17. Dongelmans DA, Paulus F, Veelo DP, et al. Adaptive sup-port ventilation may deliver unwanted respiratory rate-tidal volume combinations in patients with acute lung injury venti-lated according to an open lung concept. Anesthesiology 2011; 114(5):1138-1143. https://doi.org/10.1097/ALN.0b013e31820d8676 PMid:21383619 |
| 18. Iotti GA, Polito A, Belliato M, et al. Adaptive support ven-tilation versus conventional ventilation for total ventilatory support in acute respiratory failure. Intensive Care Med 2010 ;36(8):1371-1379. https://doi.org/10.1007/s00134-010-1917-2 PMid:20502870 |
| 19. Ghodrati M, Pournajafian A, Khatibi A, et al. Comparing the effect of adaptive support ventilation (ASV) and synchro-nized intermittent mandatory ventilation (SIMV) on respirato-ry parameters in neurosurgical ICU Patients. Anesth Pain Med 2016; 2;6(6):e40368. https://doi.org/10.5812/aapm.40368 PMid:28975076 PMCid:PMC5560625 |
| 20. El-Shenawy OM, Metwally MM, Abdel-Mabboud AE, et al. Adaptive support ventilation versus synchronized intermit-tent mandatory ventilation in patients with chronic obstruc-tive pulmonary disease. J Curr Med Res Pract 2018; 3:1-5. https://doi.org/10.4103/JCMRP.JCMRP_11_18 |
| 21. Sehgal IS, Kalpakam H, Dhooria S, et al. a randomized controlled trial of noninvasive ventilation with pressure sup-port ventilation and adaptive support ventilation in acute ex-acerbation of COPD: A feasibility Study. COPD 2019; 16(2):168-173. https://doi.org/10.1080/15412555.2019.1620716 PMid:31161812 |
| 22. Dai YL, Wu CP, Yang GG, et al. Adaptive support ventila-tion attenuates ventilator induced lung injury: human and animal study. Int J Mol Sci 2019; 20(23):5848. https://doi.org/10.3390/ijms20235848 PMid:31766467 PMCid:PMC6929029 |
| 23. Jung B, Constantin JM, Rossel N, et al. Adaptive support ventilation prevents ventilator-induced diaphragmatic dys-function in piglet: an in vivo and in vitro study. Anesthesiolo-gy 2010; 112(6):1435-1443. https://doi.org/10.1097/ALN.0b013e3181d7b036 PMid:20460996 |
| 24. Sulemanji D, Marchese A, Garbarini P, et al. Adaptive support ventilation: An appropriate mechanical ventilation strategy for acute respiratory distress syndrome? Anesthesiol-ogy 2009; 111:863-870. https://doi.org/10.1097/ALN.0b013e3181b55f8f PMid:19741490 |
| 25. Mireles-Cabodevila, E, Diaz-Guzman E, Arroliga AC, et al. Human versus computer controlled selection of ventilator settings: an evaluation of adaptive support ventilation and mid-frequency ventilation, Critical Care Research and Prac-tice 2012; 1-8. https://doi.org/10.1155/2012/204314 PMid:23119152 PMCid:PMC3478732 |
| 26. Morato JB, Sakuma MT, Ferreira JC, et al. Comparison of 3 modes of automated weaning from mechanical ventilation: a bench study. J Crit Care 2012 ;27(6):741.e1-8. https://doi.org/10.1016/j.jcrc.2011.12.021 PMid:22459160 |
| 27. hen C, Wu C, Dai Y, et al. Effects of implementing adap-tive support ventilation in a medical intensive care unit. Respir Care 2011; 56(7):976-983. https://doi.org/10.4187/respcare.00966 PMid:21352661 |