scholarly journals Automated mechanical ventilation using Adaptive Support Ventilation versus conventional ventilation including ventilator length of stay, mortality, and professional social aspects of adoption of new technology.

2021 ◽  
Vol 2 (2) ◽  
pp. 48-52
Author(s):  
Ronald Sanderson ◽  
Denise Whitley ◽  
Christopher Batacan
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Medical Center ◽  
Minute Ventilation ◽  
New Technology ◽  
Strict Adherence ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Percent Mortality ◽  
Adaptive Support

Background Automation of mechanical ventilation allows for reduction of variation in patient management and has the potential to provide increased patient safety by strict adherence to computer driven ventilator protocols. Methods: A retrospective, observational study compared a group of 196 of general ICU patients managed exclusively on automated mechanical ventilation, adaptive support ventilation (ASV), to another group of 684 managed by usual, non-automated mechanical ventilation (No ASV). The data was collected in a unique access database designed to collect data for assessment of mechanical ventilation outcomes in a small medical center ICU. Results: The length of ventilator stay was non-significant between both groups, (81.7 ± 35.2 hours) in the ASV group; vs. (94.1 ± 35.1 hours) in the No ASV. Percent mortality was significantly less in the ASV group, 8.6% compared to 27.3% in the No ASV. Conclusion: Automated ventilation appears to be a safe ventilator strategy; however, cause effect relationships cannot be determined without further, more sophisticated studies. Keywords: Closed loop ventilation, ASV, Ventilator length of stay, Percent minute ventilation

scholarly journals Effect of respiratory effort on target minute ventilation during Adaptive Support Ventilation.

2021 ◽  
Vol 2 (2) ◽  
pp. 53-58
Author(s):  
Marissa Su ◽  
ehab daoud
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Respiratory Rate ◽  
Minute Ventilation ◽  
Work Of Breathing ◽  
Simulated Patients ◽  
Respiratory Effort ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Adaptive Support

Background: Adaptive support ventilation (ASV) is an intelligent mode of mechanical ventilation protocol which uses a closed-loop control between breaths. The algorithm states that for a given level of alveolar ventilation, there is a particular respiratory rate and tidal volume which achieve a lower work of breathing. The mode allows the clinician to set a desired minute ventilation percentage (MV%) while the ventilator automatically selects the target ventilatory pattern base on these inputs and feedback from the ventilator monitoring system. The goal is to minimize the work of breathing and reduce complications by allowing the ventilator to adjust the breath delivery taking into account the patient’s respiratory mechanics (Resistance, and Compliance). In this study we examine the effect of patients’ respiratory effort on target tidal volume (VT) and Minute Ventilation (V̇e) during ASV using breathing simulator. Methods: A bench study was performed by using the ASL 5000 breathing simulator to compare the target ventilator to actual VT and V̇e value in simulated patients with various level of respiratory effort during ASV on the Hamilton G5 ventilator. The clinical scenario involves simulated adult male with IBW 70kg and normal lung mechanics: respiratory compliance of 70 mL/cm H2O, and airway resistance of 9 cm H2O/L/s. Simulated patients were subjected to five different level of muscle pressure (Pmus): 0 (Passive), -5, -10, -15, -25 (Active) cm H2O at a set respiratory rate of 10 (below targeted VT) set at three different levels of minute ventilation goals: 100%, 200%, and 300%, with a PEEP of 5 cm H2O. Fifty breaths were analyzed in every experiment. Means and standard deviations (SD) of variables were calculated. One way analysis of variants was done to compare the values. Pearson correlation coefficient test was used to calculate the correlation between the respiratory effort and the VT, V̇e, and peak inspiratory pressure (PIP). Results: The targeted VT and V̇e were not significant in the passive patient when no effort was present, however were significantly higher in the active states at all levels of Pmus on the 100%, 200% and the 300 MV%. The VT and V̇e increase correlated with the muscle effort in the 100 and 200 MV% but did not in the 300%. Conclusions: Higher inspiratory efforts resulted in significantly higher VT and V̇e than targeted ones. Estimating patients’ effort is important during setting ASV. Keywords: Mechanical ventilation, ASV, InteliVent, Pmus, tidal volume, percent minute ventilation

scholarly journals Adaptive Support Ventilation as a Sole Mode of Mechanical Ventilation-An Observational Study

2017 ◽  
Vol 1 (1) ◽  
pp. 8-12
Author(s):  
L.K. Rajbanshi ◽  
M. Dali ◽  
S.B. Karki ◽  
K. Khanal ◽  
B. Aryal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Ventilatory Support ◽  
Control Mode ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Adaptive Support ◽  
The Mean

Introduction Adaptive support ventilation (ASV) is a close loop dual control mechanical ventilation mode. This mode can automatically change its parameters to weaning mode once the patient is actively breathing converting volume targeted pressure control mode to volume targeted pressure support mode. We aimed to observe the outcome of the patients ventilated with ASV as a sole mode in terms of duration of mechanical ventilation, duration of weaning from the ventilatory support and length of Intensive care unit (ICU) stay.Methodology We conducted a prospective observational study for the duration of six months (Sept 2015 to Feb 2016) to assess the clinical outcome of the patients ventilated by ASV as a sole mode of ventilation. The study conducted observation of 78 patients without chronic respiratory, renal, hepatic and neurological disease who were admitted in our intensive care unit for invasive ventilatory support.Results Out of the 187 patients who required invasive and noninvasive ventilation, only 78 patients fulfilled the criteria to be included in the study. It was observed that the mean duration of mechanical ventilation was 5.4 days while weaning as well as tracheal extubation was successful within 13 hours of initiation of weaning. The mean duration of ICU stay was found to be 6.3 days.Conclusion We concluded that the patient ventilated by ASV mode were effectively weaned without the need of changing the ventilator mode. However, the safety of ASV mode needs to be established by large randomized control trail in a wide spectrum of patients.Birat Journal of Health Sciences 2016 1(1): 8-12

scholarly journals Human versus Computer Controlled Selection of Ventilator Settings: An Evaluation of Adaptive Support Ventilation and Mid-Frequency Ventilation

2012 ◽  
Vol 2012 ◽  
pp. 1-8
Author(s):  
Eduardo Mireles-Cabodevila ◽  
Enrique Diaz-Guzman ◽  
Alejandro C. Arroliga ◽  
Robert L. Chatburn
Keyword(s):  
Minute Ventilation ◽  
Computer Algorithms ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Clinical Scenarios ◽  
Frequency Ventilation ◽  
Paralyzed Patient ◽  
Adaptive Support ◽  
Computer Controlled ◽  
Ventilator Settings

Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes). Two examples are adaptive support ventilation (ASV) and mid-frequency ventilation (MFV). We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios.Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario’s respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings.Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes.Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme.

scholarly journals Adaptive Support Ventilation (ASV). Beneficial or not?

2021 ◽  
Vol 2 (1) ◽  
pp. 34-44
Author(s):  
Denise Wheatley ◽  
Krystal Young
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Therapist ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Respiratory Therapists ◽  
Risks And Benefits ◽  
Adaptive Support ◽  
Research Questions ◽  
Clinical Conditions ◽  
Automated Modes

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

scholarly journals Adaptive Support Ventilation versus Conventional Ventilation during Hypoxemic Respiratory Failure: A Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Wei Zhang ◽  
Xiaoli Liu ◽  
Can Jin ◽  
Longju Zhang ◽  
Zong’an Liang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Conventional Ventilation ◽  
Ventilation Mode ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Randomized Controlled ◽  
Adaptive Support

Abstract Background The purpose of the study is to examine whether the adaptive support ventilation (ASV) mode compared with conventional ventilation reduces the duration of mechanical ventilation (MV) in patients with acute respiratory failure. Methods We searched PubMed, the Cochrane Library Central Register of Controlled Trials, EMBASE and Web of Science databases from inception through July 27, 2019. We considered all the randomized controlled studies (RCTs) that examined the efficacy of ASV in comparison with conventional ventilation in mechanically ventilated adults. The primary outcomes were (1) the length of MV, (2) weaning duration and (3) length of stay (LOS) in ICU. Results We included three RCTs for the analysis enrolling a total of 374 patients. Patients treated with ASV had a lower weaning duration than patients treated with conventional ventilation (MD -28.98 [95% CI -42.42, -15.54, p˂0.0001]). Then, 28-day mortality was not different between the two groups (OR 0.95 [95%CI 0.6, 1.52, p=0.83; I2=0%, p=0.96]). The incidence of ventilator-associated pneumonia and sedation level was not included into the quantitative analysis. Conclusions The study showed that a lower number of duration of MV and a shorter number of weaning duration in acute hypoxemic respiratory failure patients treated with ASV than conventional ventilation. Keywords: pulmonary infection; critically ill patients; adaptive support ventilation; hypoxemic respiratory failure Background Acute hypoxemic respiratory failure is a severe disorder of the respiratory system to maintain oxygenation or eliminate carbon dioxide (CO2), leading to a series of metabolic disorders and physiological dysfunction. Mechanical ventilation (MV) serve as a lifesaving therapy is widely employed in intensive care units (ICU) for treating clinical symptoms related to critically illness.[1,2] Employment of mechanical ventilation in patients could help effectively to replace, control and change spontaneous breathing, reduce or eliminate respiratory muscle oxygen consumption, increasing ventilation and improving ventilation[3], removing the residual mucous in airway.[4] The choice of ventilation mode is such a very important issue in ICU that clinicians capable to choose the ventilation mode and adapt the ventilator controls according to the patient's respiratory mechanics.

scholarly journals Adaptive support ventilation attenuates postpneumonectomy acute lung injury in a porcine model

2020 ◽  
Vol 31 (5) ◽  
pp. 718-726
Author(s):  
Yu-Ling Dai ◽  
Ren-Jun Hsu ◽  
Hsu-Kai Huang ◽  
Tsai-Wang Huang ◽  
Wen-Chiuan Tsai ◽  
...  
Keyword(s):  
Lung Injury ◽  
Mechanical Stress ◽  
Minute Ventilation ◽  
Volume Control ◽  
Control Group ◽  
Breathing Patterns ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Ventilator Induced Lung Injury ◽  
Adaptive Support

Abstract OBJECTIVES An optimal ventilation strategy that causes as little mechanical stress and inflammation as possible is critical for patients undergoing pneumonectomy. The aim of this study was to determine whether adaptive support ventilation (ASV) can provide protective ventilation to the remaining lung after pneumonectomy with minimal mechanical stress and less inflammation than volume-control ventilation (VCV). METHODS In this study, 15 pigs were randomly allocated to 3 groups (n = 5 for each group): the control group, the VCV group and the ASV group. After left pneumonectomy, the VCV group was treated with the volume-control set to 20 ml/kg, and the ASV group with the mode set to achieve 60% of the minute ventilation of 2 lungs. RESULTS The ASV group had lower alveolar strain than the VCV group. The ASV group exhibited less lung injury and greater alveolar fluid clearance than the VCV group (13.3% vs −17.8%; P ≤ 0.018). Ventilator-induced lung injury was associated with changes in the cytokine levels in the exhaled breath condensate, differential changes in plasma and changes in the cytokines in the bronchoalveolar lavage fluid. Expression of 3 microRNAs (miR449b-3p, P ≤ 0.001; miR451-5p, P = 0.027; and miR144-5p, P = 0.008) was increased in the VCV group compared with the ASV group. CONCLUSIONS The ASV mode was capable of supporting rapid, shallow breathing patterns to exert lung-protective effects in a porcine postpneumonectomy model. Further investigation of microRNAs as biomarkers of ventilator-induced lung injury is warranted.

scholarly journals Guidelines on setting the target minute ventilation in Adaptive Support Ventilation

2021 ◽  
Vol 2 (3) ◽  
pp. 80-85
Author(s):  
Jean-Michel Arnal ◽  
Ehab Daoud
Keyword(s):  
Closed Loop ◽  
Minute Ventilation ◽  
Ideal Body Weight ◽  
Respiratory Pattern ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Disease States ◽  
Adaptive Support ◽  
End Tidal ◽  
Clinical Conditions

Adaptive Support Ventilation (ASV) is a fully closed loop ventilation where the operator input the desired PEEP, FiO2 and the target minute ventilation (MV) expressed as a percentage according to ideal body weight. The ventilator selects the target respiratory pattern (tidal volume, respiratory rate, and inspiratory time) based on the observed respiratory mechanics. However, there are no published guidelines on settings and adjusting the target MV in different disease states during ASV ventilation. INTELLiVENT-ASV, is the new generation modified algorithm of ASV, has made this issue much easier and simpler as the operator inputs a desired range of the end tidal exhaled carbon dioxide, and oxygen saturation and the algorithm will adjust the minute ventilation percentage as well as PEEP and FiO2 automatically to stay within that range. In this article we describe some evidence-based guidelines on how to set and adjust the target MV in various clinical conditions. Keywords: ASV, INTELLiVENT-ASV, Closed loop ventilation, End tidal CO2, ARDS, COPD, Respiratory failure

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