# Adaptive support ventilation > Mediated Wiki article. Canonical URL: https://mediated.wiki/source/Adaptive_support_ventilation > Markdown URL: https://mediated.wiki/source/Adaptive_support_ventilation.md > Source: https://en.wikipedia.org/wiki/Adaptive_support_ventilation > Source revision: 1338685250 > License: Creative Commons Attribution-ShareAlike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/) '''Adaptive support ventilation''' is a method to deliver air-oxygen mixtures to patients using an electro-pneumatic device ([ventilator](/source/ventilator)) to assist or replace breathing in [emergency care](/source/Emergency_medicine) and [intensive care medicine](/source/intensive_care_medicine). The clinician needs to set the ventilator to meet the needs of the patient by using buttons or a touch screen. The settings are complex and include: * the method of gas delivery (e.g. pressure controlled, flow controlled, volume controlled) * timing information (e.g. [respiratory rate](/source/respiratory_rate), inspiratory time, expiratory time, etc.) * sensitivity to spontaneous breathing efforts (e.g. trigger sensitivities) * [fraction of inspired oxygen](/source/fraction_of_inspired_oxygen) * [positive end-expiratory pressure](/source/positive_end-expiratory_pressure) Some methods are suitable only for completely passive patients, others only for breathing but weak patients, and others for patients with intermittent breathing activities. State of the art technology allows a rather large number of controls and adjustments which leads to a myriad of combinations, called modalities or modes of ventilation.{{Cite journal |last1=Chatburn |first1=Robert L. |last2=Mireles-Cabodevila |first2=Eduardo |date=January 2011 |title=Closed-loop control of mechanical ventilation: description and classification of targeting schemes |journal=Respiratory Care |volume=56 |issue=1 |pages=85–102 |doi=10.4187/respcare.00967 |issn=0020-1324 |pmid=21235841}} Adaptive support ventilation provides a simplified method of control for the medical personnel compared to other modes of respiratory support.{{Cite journal |last1=van Haren |first1=Lisan M. A. A. |last2=Nabben |first2=Daphne L. J. |last3=Kloeze |first3=Carla |last4=Dekker |first4=Michiel A. C. |last5=De Vries |first5=Tineke J. C. |last6=Buiteman-Kruizinga |first6=Laura A. |last7=Neto |first7=Ary Serpa |last8=van Leijsen |first8=Tobias |last9=Paulus |first9=Frederique |last10=van Meenen |first10=David M. P. |last11=Montenij |first11=Leon |last12=Korsten |first12=Erik H. M. |last13=Bindels |first13=Alexander J. G. H. |last14=Bouwman |first14=Arthur R. |last15=Schultz |first15=Marcus J. |date=2025-02-11 |title=Comparative analysis of fully automated vs. conventional ventilation in postoperative cardiac surgery patients: Impact on alarms, interventions, and nurse acceptance |journal=Intensive & Critical Care Nursing |volume=89 |article-number=103963 |doi=10.1016/j.iccn.2025.103963 |issn=1532-4036 |pmid=39938276}} It is applicable for all breathing insuffiencies, from complete absence of breathing capabilities to partial spontaneous breathing efforts.{{Cite journal |last1=Celli |first1=P. |last2=Privato |first2=E. |last3=Ianni |first3=S. |last4=Babetto |first4=C. |last5=D'Arena |first5=C. |last6=Guglielmo |first6=N. |last7=Maldarelli |first7=F. |last8=Paglialunga |first8=G. |last9=Rossi |first9=M. |last10=Berloco |first10=P. B. |last11=Ruberto |first11=F. |last12=Pugliese |first12=F. |date=September 2014 |title=Adaptive support ventilation versus synchronized intermittent mandatory ventilation with pressure support in weaning patients after orthotopic liver transplantation |journal=Transplantation Proceedings |volume=46 |issue=7 |pages=2272–2278 |doi=10.1016/j.transproceed.2014.06.046 |issn=1873-2623 |pmid=25150607}}{{Cite journal |last1=Sehgal |first1=Inderpaul Singh |last2=Kalpakam |first2=Hariprasad |last3=Dhooria |first3=Sahajal |last4=Aggarwal |first4=Ashutosh N. |last5=Prasad |first5=Kuruswamy Thurai |last6=Agarwal |first6=Ritesh |date=April 2019 |title=A Randomized Controlled Trial of Noninvasive Ventilation with Pressure Support Ventilation and Adaptive Support Ventilation in Acute Exacerbation of COPD: A Feasibility Study |journal=COPD |volume=16 |issue=2 |pages=168–173 |doi=10.1080/15412555.2019.1620716 |issn=1541-2563 |pmid=31161812}}{{Cite journal |last1=Baedorf Kassis |first1=Elias N. |last2=Bastos |first2=Andres Brenes |last3=Schaefer |first3=Maximillian S. |last4=Capers |first4=Krystal |last5=Hoenig |first5=Benjamin |last6=Banner-Goodspeed |first6=Valerie |last7=Talmor |first7=Daniel |date=December 2022 |title=Adaptive Support Ventilation and Lung-Protective Ventilation in ARDS |journal=Respiratory Care |volume=67 |issue=12 |pages=1542–1550 |doi=10.4187/respcare.10159 |issn=1943-3654 |pmid=35973716}} This does not mean that adaptive support ventilation is superior to other modalities. However, it makes the operation of the ventilator easier. == Basic principle == === Control mechanism === In adaptive support ventilation, the physician or [respiratory therapist](/source/respiratory_therapist) sets a desired [minute ventilation](/source/minute_ventilation) for a given patient, the [positive end-expiratory pressure](/source/positive_end-expiratory_pressure)) and the [oxygen content of the inspired gas](/source/fraction_of_inspired_oxygen). The respirator provides first a few test breaths to measures the rate at which the lungs can fill and empty{{Cite journal |last1=Laubscher |first1=T. P. |last2=Frutiger |first2=A. |last3=Fanconi |first3=S. |last4=Jutzi |first4=H. |last5=Brunner |first5=J. X. |date=February 1994 |title=Automatic selection of tidal volume, respiratory frequency and minute ventilation in intubated ICU patients as start up procedure for closed-loop controlled ventilation |journal=International Journal of Clinical Monitoring and Computing |volume=11 |issue=1 |pages=19–30 |doi=10.1007/BF01132840 |issn=0167-9945 |pmid=8195655}} and then calculates the desired levels of pressure to force gas into the lungs (inhalation) and the time necessary to empty the lungs thereafter (exhalation).{{Cite journal |last1=Brunner |first1=J. X. |last2=Iotti |first2=G. A. |date=May 2002 |title=Adaptive Support Ventilation (ASV) |journal=Minerva Anestesiologica |volume=68 |issue=5 |pages=365–368 |issn=0375-9393 |pmid=12029247}} If the patient has no respiratory activity, adaptive support ventilation will dictate inhalation and exhalation. If the patient has some respiratory activity left, adaptive support ventilation synchronizes with the patient's breathing. === Safety mechanism === Theoretically, the minute ventilation set by the physician can be achieved with different breathing rates and tidal volumes according to the formula MV = f x Vt with f being the respiratory rate and Vt the volume of a breath ([tidal volume](/source/tidal_volume)). Some combinations can be harmful, though. For example, a very large breath can injure the lungs. A very small tidal volume can create ineffective breathing (like panting). In contrast to another form of controlled Minute Ventilation,{{Cite journal |last1=Hewlett |first1=A. M. |last2=Platt |first2=A. S. |last3=Terry |first3=V. G. |date=February 1977 |title=Mandatory minute volume. A new concept in weaning from mechanical ventilation |journal=Anaesthesia |volume=32 |issue=2 |pages=163–169 |doi=10.1111/j.1365-2044.1977.tb11588.x |issn=0003-2409 |pmid=322535}} Adaptive support ventilation employs three fundamental safety mechanisms: # provides a minimal breath volume (Vt > Vd, where Vd is the [anatomical dead space](/source/Dead_space_(physiology))) # forces exhalation time to be long enough to avoid breath stacking (a potentially dangerous built-up of pressure{{Cite journal |last1=Pohlman |first1=Mark C. |last2=McCallister |first2=Kathryn E. |last3=Schweickert |first3=William D. |last4=Pohlman |first4=Anne S. |last5=Nigos |first5=Celerina P. |last6=Krishnan |first6=Jerry A. |last7=Charbeneau |first7=Jeff T. |last8=Gehlbach |first8=Brian K. |last9=Kress |first9=John P. |last10=Hall |first10=Jesse B. |date=November 2008 |title=Excessive tidal volume from breath stacking during lung-protective ventilation for acute lung injury |journal=Critical Care Medicine |volume=36 |issue=11 |pages=3019–3023 |doi=10.1097/CCM.0b013e31818b308b |issn=1530-0293 |pmid=18824913}}) # limits the inspiratory pressure to avoid lung injury == Implementations == Adaptive support ventilation was first introduced by the GALILEO ventilator.{{Cite journal |last1=Campbell |first1=R. S. |last2=Branson |first2=R. D. |last3=Johannigman |first3=J. A. |date=2001 |title=Adaptive support ventilation |journal=Respiratory Care Clinics of North America |volume=7 |issue=3 |pages=425–440, ix |doi=10.1016/s1078-5337(05)70049-6 |issn=1078-5337 |pmid=11517032}} The invention was claimed by different parties.{{Cite journal |last1=Brunner |first1=Josef X. |last2=Iotti |first2=Giorgio A. |date=October 2008 |title=Letter to the Editor |url=http://link.springer.com/10.1007/s10877-008-9138-8 |journal=Journal of Clinical Monitoring and Computing |language=en |volume=22 |issue=5 |pages=385–386 |doi=10.1007/s10877-008-9138-8 |pmid=18766445 |issn=1387-1307|url-access=subscription }}{{Cite web |title=Tehrani v. Hamilton Medical Inc (2003) |url=https://caselaw.findlaw.com/court/us-federal-circuit/1158485.html |access-date=2025-04-07 |website=Findlaw |language=en-US}}{{Cite web |title=Tehrani v Hamilton & ors [2021] EWHC 3457 (IPEC) |url=https://www.11southsquare.com/notable-cases/tehrani-hamilton-ors-2021-ewhc-3457-ipec/ |access-date=2025-04-07 |website=11 South Square |language=en-GB}} The basic idea was subsequently modified{{Cite journal |last1=van der Staay |first1=Matthias |last2=Chatburn |first2=Robert L. |date=December 2018 |title=Advanced modes of mechanical ventilation and optimal targeting schemes |journal=Intensive Care Medicine Experimental |language=en |volume=6 |issue=1 |page=30 |doi=10.1186/s40635-018-0195-0 |doi-access=free |pmid=30136011 |pmc=6104409 |issn=2197-425X}} to represent different mathematical models of the lung and is now available on many ventilator brands. The implementations differ from machine to machine but the underlying principle remains the same. == See also == * [Dual-control modes of ventilation](/source/Dual-control_modes_of_ventilation) * [Continuous mandatory ventilation](/source/Continuous_mandatory_ventilation) * [Nomenclature of mechanical ventilation](/source/Nomenclature_of_mechanical_ventilation) == References == Category:Mechanical ventilation --- Adapted from the Wikipedia article [Adaptive support ventilation](https://en.wikipedia.org/wiki/Adaptive_support_ventilation) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Adaptive_support_ventilation?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.