RT Journal Article SR Electronic T1 Response of Home-Use Adaptive Pressure Modes to Simulated Transient Hypoventilation JF Respiratory Care FD American Association for Respiratory Care SP 1258 OP 1267 DO 10.4187/respcare.07213 VO 65 IS 9 A1 Frédéric Lofaso A1 Karl Leroux A1 Ghilas Boussaid A1 Hélène Prigent A1 Bruno Louis YR 2020 UL http://rc.rcjournal.com/content/65/9/1258.abstract AB BACKGROUND: Adaptive servoventilation (ASV) is a recently developed ventilation mode designed to stabilize ventilation in patients with central sleep apnea and Cheyne-Stokes respiration. Alternatively, modes aiming to maintain average ventilation over several breaths, such as average volume-assured pressure support (AVAPS) and intelligent volume-assured pressure support (iVAPS), could be efficient during ventilation instability by reducing central events. These modes are available on a variety of devices. This bench evaluation studied the response of these different modes and devices to simulated transient hypoventilation events.METHODS: Three home ventilation devices operating in ASV modes (AirCurve 10 CS Pacewave, ResMed; DreamStation autoSV, Philips; Prisma CR, Löwenstein) and 2 ventilators with the AVAPS mode (DreamStation BiPAP, Philips; Lumis 150 iVAPS, ResMed) were evaluated during transient central hypopnea/hypoventilation simulations characterized by a constant breathing frequency of 15 breaths/min and a progressive decrease of tidal volume (VT) from 500 mL to 50 mL, in 18, 12, 9, and 6 breaths, respectively, followed by a progressive return to the baseline at the same rate.RESULTS: The AirCurve 10 CS Pacewave reacted to a VT decrease between 80% and 50% of baseline VT. DreamStation BiPAP and Prisma CR reacted when VT decreased to between 60% and 30% of baseline VT, whereas the AVAPS response to hypopnea occurred during the crescendo phase of hypopnea/hypoventilation VT. The iVAPS response was between that of the AirCurve 10 CS Pacewave and the other ASV devices. Among the ASV devices, the minimum VT was higher with AirCurve 10 CS Pacewave, followed by the Prisma CR and the DreamStation BiPAP. Minimum VT was not influenced by AVAPS and was improved by iVAPS without outperforming the AirCurve 10 CS Pacewave. Maximum VT was increased by iVAPS, whereas ASV devices did not induce a significant VT overshoot.CONCLUSIONS: ASV devices improved central hypopnea/hypoventilation events without inducing hyperpnea events and therefore were better adapted than AVAPS and iVAPS devices, with notable differences in their responses to hypoventilation events.