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

Abstract

Adaptive support ventilation (ASV) is a closed-loop ventilation mode that can act both as pressure support ventilation (PSV) and pressure-controlled ventilation. Weaning with ASV shows promising results, mainly in post-cardiac surgery patients. The aim of the present randomised controlled study was to test the hypothesis that weaning with ASV could reduce the weaning duration in patients with chronic obstructive pulmonary disease (COPD) when compared with PSV.From among 435 COPD patients admitted to the intensive care unit (ICU) during a 20-month period, 97 were enrolled. Patients were assigned at random to either ASV or PSV as a weaning mode.Compared with PSV, ASV provided shorter weaning times (median 24 (interquartile range 20-62) h versus 72 (24-144) h, p50.041) with similar weaning success rates (35 out of 49 for ASV and 33 out of 48 for PSV). Length of stay in the ICU was also shorter with ASV but the difference was not statistically significant.This study suggests that ASV may be used in the weaning of COPD patients with the advantage of shorter weaning times. Further studies are needed to investigate the role and potential advantages of ASV in the weaning period of different patient groups.

A Randomized Controlled Trial to Compare Adaptive Support Ventilation and Pressure Support Ventilation for Weaning COPD Patients

“…With similar results, Kirakli et al (39) reported a significant shorter duration of weaning with ASV than PSV in AECOPD patients [median (IQR) 24 (20-62) h versus 72 (24-144) h, p = 0.041]. ICU stay was also shorter in ASV group [median (IQR) 11 (6-15) days versus 13 (8)(9)(10)(11)(12)(13)(14) days, p = 0.5] but this difference was not statistically significant, while results from our study had significantly shorter LOS in ICU [median (IQR) 4 (2.5-9) days versus 6 (3-11) days, p < 0.001].…”

A Randomized Controlled Trial Comparing the Ventilation Duration Between Adaptive Support Ventilation and Pressure Assist/Control Ventilation in Medical Patients in the ICU

“…These studies reported reductions in the controlled and assisted phases of ventilation, duration until weaning and total MV duration or no difference but with less manual settings of the ventilator with ASV 2-4 . In a previous study we used ASV only in the weaning period of COPD patients and found a reduction in the weaning duration 5 . The use of ASV from intubation to extubation during the entire ventilation period in the present study might be the cause of the additional reduction in the duration of MV until weaning.…”

“…Some studies reported shorter weaning times, less alarms and fewer manipulations with ASV as compared to conventional modes, especially in the weaning period [2][3][4][5] .…”

Safety and efficacy of a fully closed-loop control ventilation (IntelliVent-ASV®) in sedated ICU patients with acute respiratory failure: a prospective randomized crossover study

“…Among them, adaptive support ventilation (ASV) adapts ventilator support in passive patients, transitions patients from controlled to supported modes and automates the weaning process. By adjusting ventilator settings to respiratory mechanics, ASV can select individualized breath patterns [3] with reduced tidal volume (V T ) for patients with acute respiratory distress syndrome (ARDS) [4], and reduce weaning duration in post cardiac surgery patients [5] and in ICU patients [6,7]. IntelliVent-ASV Ò (Hamilton Medical, Rhäzüns, Switzerland) is a recently released development of ASV that automatically adjusts both ventilation and oxygenation parameters.…”