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Research ArticleOriginal Research

Adaptive Support Ventilation and Lung-Protective Ventilation in ARDS

Elias N Baedorf Kassis, Andres Brenes Bastos, Maximillian S Schaefer, Krystal Capers, Benjamin Hoenig, Valerie Banner-Goodspeed and Daniel Talmor
Respiratory Care December 2022, 67 (12) 1542-1550; DOI: https://doi.org/10.4187/respcare.10159
Elias N Baedorf Kassis
Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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  • For correspondence: [email protected]
Andres Brenes Bastos
Department of Anesthesia, Yale School of Medicine, New Haven, Connecticut.
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Maximillian S Schaefer
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Krystal Capers
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Benjamin Hoenig
Albany Medical College, Albany, New York.
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Valerie Banner-Goodspeed
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Daniel Talmor
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Abstract

BACKGROUND: Adaptive support ventilation (ASV) is a partially closed-loop ventilation mode that adjusts tidal volume (VT) and breathing frequency (f) to minimize mechanical work and driving pressure. ASV is routinely used but has not been widely studied in ARDS.

METHODS: The study was a crossover study with randomization to intervention comparing a pressure-regulated, volume-targeted ventilation mode (adaptive pressure ventilation [APV], standard of care at Beth Israel Deaconess Medical Center) set to VT 6 mL/kg in comparison with ASV mode where VT adjustment is automated. Subjects received standard of care (APV) or ASV and then crossed over to the alternate mode, maintaining consistent minute ventilation with 1–2 h in each mode. The primary outcome was VT corrected for ideal body weight (IBW) before and after crossover. Secondary outcomes included driving pressure, mechanics, gas exchange, mechanical power, and other parameters measured after crossover and longitudinally.

RESULTS: Twenty subjects with ARDS were consented, with 17 randomized and completing the study (median PaO2/FIO2 146.6 [128.3–204.8] mm Hg) and were mostly passive without spontaneous breathing. ASV mode produced marginally larger VT corrected for IBW (6.3 [5.9–7.0] mL/kg IBW vs 6.04 [6.0–6.1] mL/kg IBW, P = .035). Frequency was lower with patients in ASV mode (25 [22–26] breaths/min vs 27 [22–30)] breaths/min, P = .01). In ASV, lower respiratory-system compliance correlated with smaller delivered VT/IBW (R2 = 0.4936, P = .002). Plateau (24.7 [22.6–27.6] cm H2O vs 25.3 [23.5–26.8] cm H2O, P = .14) and driving pressures (12.8 [9.0–15.8] cm H2O vs 11.7 [10.7–15.1] cm H2O, P = .29) were comparable between conventional ventilation and ASV. No adverse events were noted in either ASV or conventional group related to mode of ventilation.

CONCLUSIONS: ASV targeted similar settings as standard of care consistent with lung-protective ventilation strategies in mostly passive subjects with ARDS. ASV delivered VT based upon respiratory mechanics, with lower VT and mechanical power in subjects with stiffer lungs.

  • ASV
  • ARDS
  • mechanical ventilation
  • driving pressure
  • transpulmonary pressure
  • esophageal balloon
  • lung-protective ventilation

Footnotes

  • Correspondence: Elias N Baedorf Kassis MD. E-mail: enbaedor{at}bidmc.harvard.edu
  • Drs Baedorf Kassis and Talmor disclose a relationship with Hamilton Medical. The remaining authors have disclosed no conflicts of interest.

  • This work was performed via internal departmental funding at Beth Israel Deaconess Medical Center, Boston, Massachusetts.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (12)
Respiratory Care
Vol. 67, Issue 12
1 Dec 2022
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Adaptive Support Ventilation and Lung-Protective Ventilation in ARDS
Elias N Baedorf Kassis, Andres Brenes Bastos, Maximillian S Schaefer, Krystal Capers, Benjamin Hoenig, Valerie Banner-Goodspeed, Daniel Talmor
Respiratory Care Dec 2022, 67 (12) 1542-1550; DOI: 10.4187/respcare.10159

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Adaptive Support Ventilation and Lung-Protective Ventilation in ARDS
Elias N Baedorf Kassis, Andres Brenes Bastos, Maximillian S Schaefer, Krystal Capers, Benjamin Hoenig, Valerie Banner-Goodspeed, Daniel Talmor
Respiratory Care Dec 2022, 67 (12) 1542-1550; DOI: 10.4187/respcare.10159
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Keywords

  • ASV
  • ARDS
  • mechanical ventilation
  • driving pressure
  • transpulmonary pressure
  • esophageal balloon
  • lung-protective ventilation

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