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Adaptive support ventilation (ASV) is a type of mechanical ventilation, which is a relatively newer mode of closed-loop ventilation. Other modes of mechanical ventilation include proportional assist ventilation, neurally adjusted ventilatory assistance, and knowledge-based systems. Many of the contemporary modes of ventilation are known to result in barotrauma, volutrauma, ineffective weaning, or prolonged weaning, higher hospital costs, and demanding one-to-one and vigilant, critical care staff. This activity reviews the ventilatory mode of adaptive support ventilation and its advancements in ventilating patients in critical care. This article demonstrates the advancements in mechanical ventilation and highlights the role of the interprofessional team in improving care for patients with ASV mode. Objectives: Describe the mechanism and principles of mechanical ventilation in the mode of adaptive support ventilation. Review the latest clinical studies and the stance of adaptive support ventilation in the present day. Identify the conditions intensivists might use or prefer ASV over other modes of ventilation. Explain the advantages of ASV over other forms of ventilation. Access free multiple choice questions on this topic.

Adaptive support ventilation (ASV) is a type of mechanical ventilation which is a relatively newer mode of closed-loop ventilation. The feature was introduced in the Galileo ventilator (Hamilton Medical, 1994). Hewlett first described it in 1977 as a form of mandatory minute ventilation (MMV) with adaptive pressure control.[1] The invention is credited to Dr. Fleur T Tehrani, who used a modified Otis equation. ASV is also called the “no mode” or “integrated mode” or the “three in one way” because of its highly adaptive characteristic to alter its ventilatory settings, which are not found in other closed-loop modes of ventilation. Other modes include proportional assist ventilation (PAV), neurally adjusted ventilatory assistance (NAVA), and knowledge-based systems (KBS).

The goal of adaptive support ventilation (ASV) mode is to ensure adequate alveolar ventilation, minimizing the WOB and transitioning the patient to an optimal ventilatory pattern by deductively preventing barotrauma, volutrauma, and air-trapping.[10] Damage of the lung tissue due to high-volume ventilation occurs with surfactant inactivation and increased microvascular permeability.[14]

Ventilator management is a multidisciplinary effort. When you put a patient on adaptive support ventilation (ASV) mode on a ventilator, it requires the clinical staff to be trained and familiar with this mode of ventilation. At the same time, this is an extremely safe mode of ventilation and weaning. A point to consider is, there is no backup mode while you wean a patient on this mode. There is a risk of hypoventilation and hypercapnia if you have set the patient on the lower percent of minute ventilation support. Familiarity and training regarding this mode of the ventilator are essential among the staff when they are managing the patient on the adaptive mode of the ventilator.