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 Technologies

Adaptive Support Ventilation®. Ventilation adapted to the patient

Graphical illustration: Clock with arrow clockwise, representation for around the clock

Around the clock. Adapting to the patient 24/7

Adaptive Support Ventilation (ASV) is a ventilation mode that selects and continuously adapts respiratory rate, tidal volume, and inspiratory time depending on the patient’s lung mechanics and effort.

Breath by breath, 24 hours a day, from intubation to extubation.

Graphic illustration: human lung with symbol "protective shield" as sign for lung protection

Follow the rules! Lung protection with every breath

ASV automatically employs lung-protective strategies to minimize complications from AutoPEEP and volutrauma/barotrauma (Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM. Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?. Anesthesiology. 2009;111(4):863-870. doi:10.1097/ALN.0b013e3181b55f8f1​). It also helps to prevent apnea, tachypnea, dead-space ventilation, and excessively large breaths (Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM. Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?. Anesthesiology. 2009;111(4):863-870. doi:10.1097/ALN.0b013e3181b55f8f1​).

Within the rules of this lung-protective strategy, ASV encourages the patient to breathe spontaneously (Petter AH, Chioléro RL, Cassina T, Chassot PG, Müller XM, Revelly JP. Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg. 2003;97(6):1743-1750. doi:10.1213/01.ANE.0000086728.36285.BE2​, Linton D, Brunner J, Laubscher T. Continuous use of an adaptive lung ventilation controller in critically ill patients in a multi-disciplinary intensive care unit .Sou Af Med J. 1995 May;85(5): 432-5.3​).

Craig Jolly Ken Hargett

Customer voices

What ASV does for us as therapists is it allows us to make sure that we are crafting the breath as adequately as possible for that patient at that time.

Craig Jolly

RRT, Adult Clinical Education Coordinator
University Medical Center, Lubbock (TX), USA

Customer voices

ASV adapts to the patient's needs by continuously adjusting the pressure needed while maintaining a safe ventilation range. It provides all levels of respiratory support regardless what the patient’s needs are.

Ken Hargett

Director Respiratory Care (until 2018)
The Methodist Hospital, Houston (TX), USA

Doctor using ASV mode on a ventilator Doctor using ASV mode on a ventilator

How does it work? ASV explained at the bedside

In this video, Dr. Jean-Michel Arnal, Senior Intensivist, gives you a quick demonstration of the main functionalities and settings in ASV on a real ICU patient.

Statistic graphic: Chen C-W. Respir Care. 2011 jul;56(7):976-983.

Do you have proof? A look at the evidence

  • In active patients, ASV decreases work of breathing and improves patient-ventilator synchrony (Wu CP, Lin HI, Perng WC, et al. Correlation between the %MinVol setting and work of breathing during adaptive support ventilation in patients with respiratory failure. Respir Care. 2010;55(3):334-341. 4​, Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med. 2002;30(4):801-807. doi:10.1097/00003246-200204000-000145​)
  • In the ICU, ASV decreases the weaning duration in patients recovering from acute respiratory failure (Chen CW, Wu CP, Dai YL, et al. Effects of implementing adaptive support ventilation in a medical intensive care unit. Respir Care. 2011;56(7):976-983. doi:10.4187/respcare.009666​) and COPD patients (Kirakli C, Ozdemir I, Ucar ZZ, Cimen P, Kepil S, Ozkan SA. Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. Eur Respir J. 2011;38(4):774-780. doi:10.1183/09031936.000815107​)
  • In post-cardiac surgery, ASV allows earlier extubation than conventional modes (Gruber PC, Gomersall CD, Leung P, et al. Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery. Anesthesiology. 2008;109(1):81-87. doi:10.1097/ALN.0b013e31817881fc8​, Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology. 2001;95(6):1339-1345. doi:10.1097/00000542-200112000-000109​) with fewer manual adjustments (Petter AH, Chioléro RL, Cassina T, Chassot PG, Müller XM, Revelly JP. Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg. 2003;97(6):1743-1750. doi:10.1213/01.ANE.0000086728.36285.BE2​) and fewer ABG analyses performed (Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology. 2001;95(6):1339-1345. doi:10.1097/00000542-200112000-000109​)
  • The driving pressure (ΔP) applied to the respiratory system in pediatric patients is lower using ASV 1.1 compared to APV-CMV (Ceylan G, Topal S, Atakul G, et al. Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients. Pediatr Pulmonol. 2021;56(9):3035-3043. doi:10.1002/ppul.2556110​)
  • Compared with PCV, ASV decreases the mechanical power transferred from the ventilator to the respiratory system by lowering pressure and respiratory rate (Buiteman-Kruizinga LA, Mkadmi HE, Schultz MJ, Tangkau PL, van der Heiden PLJ. Comparison of Mechanical Power During Adaptive Support Ventilation Versus Nonautomated Pressure-Controlled Ventilation-A Pilot Study. Crit Care Explor. 2021;3(2):e0335. Published 2021 Feb 15. doi:10.1097/CCE.000000000000033511​)
Graphic illustration: student holding certificate in her hand

Good to know! ASV training resources

Availability

ASV is a standard ventilation mode on all our critical care ventilators.

References

  1. 1. Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM. Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?. Anesthesiology. 2009;111(4):863-870. doi:10.1097/ALN.0b013e3181b55f8f
  2. 2. Petter AH, Chioléro RL, Cassina T, Chassot PG, Müller XM, Revelly JP. Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg. 2003;97(6):1743-1750. doi:10.1213/01.ANE.0000086728.36285.BE
  3. 3. Linton D, Brunner J, Laubscher T. Continuous use of an adaptive lung ventilation controller in critically ill patients in a multi-disciplinary intensive care unit .Sou Af Med J. 1995 May;85(5): 432-5.
  4. 4. Wu CP, Lin HI, Perng WC, et al. Correlation between the %MinVol setting and work of breathing during adaptive support ventilation in patients with respiratory failure. Respir Care. 2010;55(3):334-341.
  5. 5. Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med. 2002;30(4):801-807. doi:10.1097/00003246-200204000-00014
  6. 6. Chen CW, Wu CP, Dai YL, et al. Effects of implementing adaptive support ventilation in a medical intensive care unit. Respir Care. 2011;56(7):976-983. doi:10.4187/respcare.00966

 

  1. 7. Kirakli C, Ozdemir I, Ucar ZZ, Cimen P, Kepil S, Ozkan SA. Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. Eur Respir J. 2011;38(4):774-780. doi:10.1183/09031936.00081510
  2. 8. Gruber PC, Gomersall CD, Leung P, et al. Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery. Anesthesiology. 2008;109(1):81-87. doi:10.1097/ALN.0b013e31817881fc
  3. 9. Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology. 2001;95(6):1339-1345. doi:10.1097/00000542-200112000-00010
  4. 10. Ceylan G, Topal S, Atakul G, et al. Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients. Pediatr Pulmonol. 2021;56(9):3035-3043. doi:10.1002/ppul.25561
  5. 11. Buiteman-Kruizinga LA, Mkadmi HE, Schultz MJ, Tangkau PL, van der Heiden PLJ. Comparison of Mechanical Power During Adaptive Support Ventilation Versus Nonautomated Pressure-Controlled Ventilation-A Pilot Study. Crit Care Explor. 2021;3(2):e0335. Published 2021 Feb 15. doi:10.1097/CCE.0000000000000335

Footnotes

 

Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?

Authors: Demet Sulemanji, Andrew Marchese, Paul Garbarini, Marc Wysocki, Robert M Kacmarek

Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management.

Authors: Alexander H Petter, René L Chioléro, Tiziano Cassina, Pierre-Guy Chassot, Xavier M Müller, Jean-Pierre Revelly

Continuous use of an adaptive lung ventilation controller in critically ill patients in a multi-disciplinary intensive care unit

Authors: D Linton, J Brunner, T Laubscher

Correlation between the %MinVol setting and work of breathing during adaptive support ventilation in patients with respiratory failure.

Authors: Chin-Pyng Wu, Hen-I Lin, Wann-Chern Perng, Shih-Hsing Yang, Chien-Wen Chen, Yuh-Chin T Huang, Kun-Lun Huang

Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support.

Authors: Didier Tassaux, Eric Dalmas, Pierre Gratadour, Philippe Jolliet

Effects of implementing adaptive support ventilation in a medical intensive care unit.

Authors: Chien-Wen Chen, Chin-Pyng Wu, Yu-Ling Dai, Wann-Cherng Perng, Chih-Feng Chian, Wen-Lin Su, Yuh-Chin T Huang

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial.

Authors: C Kirakli, I Ozdemir, Z Z Ucar, P Cimen, S Kepil, S A Ozkan

Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery.

Authors: Pascale C Gruber, Charles D Gomersall, Patricia Leung, Gavin M Joynt, Siu Keung Ng, Ka-Man Ho, Malcolm J Underwood

Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study.

Authors: C F Sulzer, R Chioléro, P G Chassot, X M Mueller, J P Revelly

Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients.

Authors: Gokhan Ceylan, Sevgi Topal, Gulhan Atakul, Mustafa Colak, Ekin Soydan, Ozlem Sandal, Ferhat Sari, Hasan Ağın

Comparison of Mechanical Power During Adaptive Support Ventilation Versus Nonautomated Pressure-Controlled Ventilation-A Pilot Study.

Authors: Laura A Buiteman-Kruizinga, Hassan E Mkadmi, Marcus J Schultz, Peter L Tangkau, Pim L J van der Heiden