Adaptive Support Ventilation® (ASV®)
- Intelligent ventilation mode for passive and spontaneously breathing adult and pediatric patients
- Automatically adjusts ventilation to lung mechanics and applies lung-protective strategies
- Shortens ventilation time
Ventilation adapted to the patient
All Hamilton Medical ventilators feature the intelligent ventilation mode Adaptive Support Ventilation (ASV). ASV adjusts respiratory rate, tidal volume, and inspiratory time continuously depending on the patient’s lung mechanics and effort. ASV adapts ventilation breath-by-breath, 24 hours a day, and from intubation to extubation.
ASV automatically employs lung-protective strategies to minimize complications from AutoPEEP and volutrauma/barotrauma. It also prevents apnea, tachypnea, dead space ventilation, and excessively large breaths. Within the rules of this lung-protective strategy, ASV encourages the patient to breathe spontaneously.
ASV is a well established mode in critical care since 1998 and has become a standard mode in many units around the world. ASV has been successfully used in a variety of patient groups — including post-operative, COPD, and ARDS patients (Celli 2014, Agarwal 2013, Kirakli 2011, Gruber 2008, Sulzer 2001).
What customers say about ASV
Dr. Olivier Seiler
Deputy Medical Director (till 2014)
Rega Air Ambulance, Zurich, Switzerland
ASV in particular has proven its worth in everyday use. Our crews are highly enthusiastic about it. They say that they don’t have to worry about the ventilation and can focus on setting the patient up.
Director Respiratory Care
The Methodist Hospital, Houston (TX), USA
ASV adapts to the patient's needs by continuously adjusting the pressure needed while maintaining a safe ventilation range. It provides all levels of ventilation regardless what the patient’s needs are.
Adult Clinical Education Coordinator
University Medical Center, Lubbock (TX), USA
What ASV does for us as therapists is it allows us to make sure that we are crafting the breath in the absolutely best possible way for that patient at that time.
Scientific evidence on ASV
Since its introduction in 1998, ASV has received a lot of interest from the scientific community and has been the topic of well over 30 studies.
Studies show that:
- In passive patients, ASV selects different tidal volume / respiratory rate combinations for normal lung, COPD, and ARDS patients (Arnal 2008).
- In active patients, ASV decreases work of breathing and improves patient-ventilator synchrony (Wu 2010, Tassaux 2010).
- In the ICU, ASV decreases the weaning duration in medical patients (Chen 2011) and COPD patients (Kirakli 2011).
- In post-cardiac surgery, ASV allows earlier extubation than conventional modes (Gruber 2008, Sulzer 2001) with fewer manual adjustments (Petter 2003) and fewer ABG analyses performed (Sulzer 2001).
The bibliography gives an overview of the results of the studies on ASV and of some of the underlying principles.
How ASV works
ASV maintains an operator set minute volume and automatically determines an optimal tidal volume / respiratory rate combination based on the minimal work of breathing principle described by Otis (Otis 1954). ASV takes into account the patient’s respiratory mechanics, which are measured breath-by-breath by the proximal flow sensor. ASV ensures optimal ventilation for each patient during passive ventilation, spontaneous breathing, and weaning.
ASV in passive patients
In passive patients, ASV is a volume-targeted pressure controlled mode with automatic adjustment of inspiratory pressure, respiratory rate, and inspiratory/expiratory time ratio. Maximum tidal volume is controlled by setting a maximum inspiratory pressure. Expiratory time is determined according to the expiratory time constant in order to prevent dynamic hyperinflation.
ASV in active patients
In spontaneously breathing patients, ASV is a volume-targeted pressure support mode with automatic adjustment of pressure support according to the spontaneous respiratory rate. The automatic decrease of pressure support when the patient recovers their inspiratory strength is very useful for weaning. ASV can also be used to perform a weaning trial before extubation.
Availability of ASV
ASV is available on all current Hamilton Medical mechanical ventilators.
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Arnal J-M, Wysocki M, Nafati C, Donati S, Granier I, Corno G, et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med. 2008 Jan;34(1):75‑81.
Celli P, Privato E, Ianni S, Babetto C, D'Arena C, Guglielmo N, Maldarelli F, Paglialunga G, Rossi M, Berloco PB, Ruberto F, Pugliese F. Adaptive support ventilation versus synchronized intermittent mandatory ventilation with pressure support in weaning patients after orthotopic liver transplantation. Transplant Proc. 2014 Sep;46(7):2272-8.
Chen C-W, Wu C-P, Dai Y-L, Perng W-C, Chian C-F, Su W-L, et al. Effects of implementing adaptive support ventilation in a medical intensive care unit. Respir Care. 2011 Jul;56(7):976‑983.
Gruber PC, Gomersall CD, Leung P, Joynt GM, Ng SK, Ho K-M, 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 Jul;109(1):81‑87.
Iotti GA, Polito A, Belliato M, Pasero D, Beduneau G, Wysocki M, et al. Adaptive support ventilation versus conventional ventilation for total ventilatory support in acute respiratory failure. Intensive Care Med. 2010 Aug;36(8):1371‑1379.
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 Oct;38(4):774‑780.
Otis AB. The work of breathing. Physiol Rev. 1954 Jul;34(3):449-58
Petter AH, Chioléro RL, Cassina T, Chassot P-G, Müller XM, Revelly J-P. Automatic « respirator/weaning » with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg. 2003 Dec;97(6):1743‑1750.
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 Dec;95(6):1339‑1345.
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 Apr;30(4):801‑807.
Wu C-P, Lin H-I, Perng W-C, Yang S-H, Chen C-W, Huang Y-CT, et al. Correlation between the %MinVol setting and work of breathing during adaptive support ventilation in patients with respiratory failure. Respir Care. 2010 Mar;55(3):334‑341.