Adaptive Support Ventilation (ASV). Beneficial or not?

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

Rapid On-Site Cytologic Evaluation: A Feasibility Study Using Ancillary Interventional Pulmonary Personnel

<b><i>Background:</i></b> Ancillary health professionals helping in a procedural service is a common practice everywhere. <b><i>Objectives:</i></b> This was a proof-of-concept study to assess feasibility of using ancillary personnel for rapid on-site cytologic evaluation (ROSE) at interventional pulmonary procedures. <b><i>Methods:</i></b> After a training interval, a respiratory therapist (RT) performed ROSE on consecutive interventional pulmonary specimens. Sample sites included lymph nodes, lung, liver, and the left adrenal gland. RT findings were subsequently correlated with blinded cytopathology-performed ROSE and with final histopathology results, with primary foci of adequacy and the presence or absence of malignancy. <b><i>Results:</i></b> Seventy consecutive cases involved 163 separate sites for ROSE analysis. <b><i>Adequacy:</i></b> There was a high level of concordance between RT-performed ROSE (RT-ROSE) and cytopathology ROSE (CYTO-ROSE). They agreed upon the adequacy of 159 specimens. The Cohen’s κ coefficient ± asymptotic standard error (ASE) was 0.74 ± 0.175, with <i>p</i> &#x3c; 0.0001. <b><i>Malignancy:</i></b> RT-ROSE concurred highly with CYTO-ROSE, with agreement on 150 (92%) of the 163 specimens. Cohen’s κ coefficient ± ASE was 0.83 ± 0.045, with <i>p</i> &#x3c; 0.0001. When the comparison was for malignancy by case rather than individual site, Cohen’s κ coefficient ± ASE was 0.68 ± 0.08, with <i>p</i> &#x3c; 0.0001. <b><i>Conclusion:</i></b> This study demonstrates that ancillary personnel supporting an interventional pulmonary service can be trained to perform initial ROSE. Cytopathology can be called after sampling and staining have produced adequate samples. This setup streamlines ROSE evaluation with regard to time and cost.