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.
Department of Anesthesia, Yale School of Medicine, New Haven, Connecticut.
Respir Care. 2022 Dec;67(12):1542-1550. doi: 10.4187/respcare.10159. Epub 2022 Aug 16.
Adaptive support ventilation (ASV) is a partially closed-loop ventilation mode that adjusts tidal volume (V) and breathing frequency (f) to minimize mechanical work and driving pressure. ASV is routinely used but has not been widely studied in ARDS.
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 V 6 mL/kg in comparison with ASV mode where V 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 V 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.
Twenty subjects with ARDS were consented, with 17 randomized and completing the study (median P /F 146.6 [128.3-204.8] mm Hg) and were mostly passive without spontaneous breathing. ASV mode produced marginally larger V corrected for IBW (6.3 [5.9-7.0] mL/kg IBW vs 6.04 [6.0-6.1] mL/kg IBW, = .035). Frequency was lower with patients in ASV mode (25 [22-26] breaths/min vs 27 [22-30)] breaths/min, = .01). In ASV, lower respiratory-system compliance correlated with smaller delivered V/IBW (R = 0.4936, = .002). Plateau (24.7 [22.6-27.6] cm HO vs 25.3 [23.5-26.8] cm HO, = .14) and driving pressures (12.8 [9.0-15.8] cm HO vs 11.7 [10.7-15.1] cm HO, = .29) were comparable between conventional ventilation and ASV. No adverse events were noted in either ASV or conventional group related to mode of ventilation.
ASV targeted similar settings as standard of care consistent with lung-protective ventilation strategies in mostly passive subjects with ARDS. ASV delivered V based upon respiratory mechanics, with lower V and mechanical power in subjects with stiffer lungs.
适应性支持通气（ASV）是一种部分闭环通气模式，可调整潮气量（V）和呼吸频率（f），以将机械功和驱动压最小化。ASV 已常规使用，但在 ARDS 中尚未广泛研究。
这是一项交叉研究，采用随机分组比较压力调节、容量目标通气模式（适应性压力通气 [APV]，Beth Israel Deaconess Medical Center 的标准治疗方法）设定为 6 mL/kg 理想体重（IBW）与 ASV 模式（V 自动调整）。受试者接受标准治疗（APV）或 ASV，然后交叉到另一种模式，在每种模式下保持 1-2 小时的恒定分钟通气量。主要结局是交叉前后校正 IBW 的 V。次要结局包括驱动压、力学、气体交换、机械功率和交叉后及纵向测量的其他参数。
20 名 ARDS 患者同意入组，其中 17 名患者随机分组并完成研究（中位 P/F 146.6 [128.3-204.8]mmHg），主要为无自主呼吸的被动患者。ASV 模式产生的校正 IBW 的 V 稍大（6.3 [5.9-7.0]mL/kg IBW 比 6.04 [6.0-6.1]mL/kg IBW， =.035）。ASV 模式下的频率较低（25 [22-26]次/分钟比 27 [22-30]次/分钟， =.01）。在 ASV 中，较低的呼吸系统顺应性与较小的输送 V/IBW 相关（R = 0.4936， =.002）。平台压（24.7 [22.6-27.6]cm H2O 比 25.3 [23.5-26.8]cm H2O， =.14）和驱动压（12.8 [9.0-15.8]cm H2O 比 11.7 [10.7-15.1]cm H2O， =.29）在常规通气和 ASV 之间相似。在 ASV 或常规组中，均未观察到与通气模式相关的不良事件。
ASV 设定的目标与 ARDS 中大多数被动患者的肺保护性通气策略一致，与标准治疗一致。ASV 根据呼吸力学输送 V，在肺部较僵硬的患者中输送较低的 V 和机械功率。
