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Adaptive Support Ventilation®。 适应病人的通气

图:指针顺时针旋转的钟表,表示全天候

全天候。 全天候适应病人

适应性支持通气 (ASV) 是一种根据病人的肺力学指标和呼吸用力选择和连续适应呼吸频率、潮气量和吸气时间的通气模式。

按照逐次呼吸,全天候,从插管到拔管。

图:带有“保护屏障”肺保护符号的人肺

遵循规则! 每次呼吸时均提供肺保护

ASV 自动采用肺保护策略,以最大程度减少内源性 PEEP 和容积伤/气压伤等并发症 (Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM.Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?.Anesthesiology.2009;111(4):863-870. doi:10.1097/ALN.0b013e3181b55f8f1​)。它还预防窒息、呼吸急促、死腔通气和过量呼吸 (Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM.Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?.Anesthesiology.2009;111(4):863-870. doi:10.1097/ALN.0b013e3181b55f8f1​)。

在肺保护性策略规则范围内,ASV 促进病人自主呼吸 (Petter AH, Chioléro RL, Cassina T, Chassot PG, Müller XM, Revelly JP.Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management.Anesth Analg.2003;97(6):1743-1750. doi:10.1213/01.ANE.0000086728.36285.BE2​, Linton D, Brunner J, Laubscher T. Continuous use of an adaptive lung ventilation controller in critically ill patients in a multi-disciplinary intensive care unit .Sou Af Med J. 1995 May;85(5): 432-5.3​)。

Craig Jolly Ken Hargett

客户评语

ASV 对我们治疗师的帮助在于它确保我们尽可能以适当的方式精巧地为当时病人通气。

Craig Jolly

RRT,成人临床教育协调员
美国德克萨斯州拉伯克大学医疗中心

客户评语

在维持安全通气范围的同时,ASV 通过连续调整所需压力适应病人需要。它根据病人需要提供各种级别的呼吸支持。

Ken Hargett

呼吸治疗主任(直至 2018 年)
美国德克萨斯州休斯敦卫理公会医院

使用呼吸机上的 ASV 模式的医生 使用呼吸机上的 ASV 模式的医生

工作原理是什么? ASV 提供床旁说明

在本视频中,高级医师 Jean-Michel Arnal 博士在真实 ICU 病人中为您快速演示了 ASV 的主要功能和设置。

统计图:Chen C-W. Respir Care.2011 jul;56(7):976-983.

您有证据吗? 了解证据

  • 对于主动型病人,ASV 减小呼吸用力,改善病人和呼吸机的人机同步性 (Wu CP, Lin HI, Perng WC, et al.Correlation between the %MinVol setting and work of breathing during adaptive support ventilation in patients with respiratory failure.Respir Care.2010;55(3):334-341.4​, Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support.Crit Care Med.2002;30(4):801-807. doi:10.1097/00003246-200204000-000145​)
  • 在 ICU,采用 ASV 可缩短急性呼吸衰竭恢复过程中病人 (Chen CW, Wu CP, Dai YL, et al.Effects of implementing adaptive support ventilation in a medical intensive care unit.Respir Care.2011;56(7):976-983. doi:10.4187/respcare.009666​) 和 COPD 病人的撤机时间 (Kirakli C, Ozdemir I, Ucar ZZ, Cimen P, Kepil S, Ozkan SA.Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial.Eur Respir J. 2011;38(4):774-780. doi:10.1183/09031936.000815107​)
  • 心脏手术后,与常规模式相比,采用 ASV 可更早拔管 (Gruber PC, Gomersall CD, Leung P, et al.Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery.Anesthesiology.2008;109(1):81-87. doi:10.1097/ALN.0b013e31817881fc8​, Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP.Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study.Anesthesiology.2001;95(6):1339-1345. doi:10.1097/00000542-200112000-000109​),且需要的手动调整 (Petter AH, Chioléro RL, Cassina T, Chassot PG, Müller XM, Revelly JP.Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management.Anesth Analg.2003;97(6):1743-1750. doi:10.1213/01.ANE.0000086728.36285.BE2​) 和 ABG 分析更少 (Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP.Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study.Anesthesiology.2001;95(6):1339-1345. doi:10.1097/00000542-200112000-000109)
  • 相比 APV-CMV,采用 ASV 1.1 时儿童病人中应用于呼吸系统的驱动压力 (ΔP) 更低 (Ceylan G, Topal S, Atakul G, et al.Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients.Pediatr Pulmonol.2021;56(9):3035-3043. doi:10.1002/ppul.2556110​)
  • 相比 PCV,采用 ASV 可通过减少压力和呼吸频率来降低从呼吸机转移到呼吸系统的机械功率 (Buiteman-Kruizinga LA, Mkadmi HE, Schultz MJ, Tangkau PL, van der Heiden PLJ.Comparison of Mechanical Power During Adaptive Support Ventilation Versus Nonautomated Pressure-Controlled Ventilation-A Pilot Study.Crit Care Explor.2021;3(2):e0335.Published 2021 Feb 15. doi:10.1097/CCE.000000000000033511​)
图:手持证书的学生

不可不知! ASV 培训资源

可用性

ASV 是我们所有重症监护呼吸机上的一个标准通气模式。

参考文献

  1. 1. Sulemanji D, Marchese A, Garbarini P, Wysocki M, Kacmarek RM. Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?. Anesthesiology. 2009;111(4):863-870. doi:10.1097/ALN.0b013e3181b55f8f
  2. 2. Petter AH, Chioléro RL, Cassina T, Chassot PG, Müller XM, Revelly JP. Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg. 2003;97(6):1743-1750. doi:10.1213/01.ANE.0000086728.36285.BE
  3. 3. Linton D, Brunner J, Laubscher T. Continuous use of an adaptive lung ventilation controller in critically ill patients in a multi-disciplinary intensive care unit .Sou Af Med J. 1995 May;85(5): 432-5.
  4. 4. Wu CP, Lin HI, Perng WC, et al. Correlation between the %MinVol setting and work of breathing during adaptive support ventilation in patients with respiratory failure. Respir Care. 2010;55(3):334-341.
  5. 5. Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med. 2002;30(4):801-807. doi:10.1097/00003246-200204000-00014
  6. 6. Chen CW, Wu CP, Dai YL, et al. Effects of implementing adaptive support ventilation in a medical intensive care unit. Respir Care. 2011;56(7):976-983. doi:10.4187/respcare.00966

 

  1. 7. Kirakli C, Ozdemir I, Ucar ZZ, Cimen P, Kepil S, Ozkan SA. Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. Eur Respir J. 2011;38(4):774-780. doi:10.1183/09031936.00081510
  2. 8. Gruber PC, Gomersall CD, Leung P, et al. Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery. Anesthesiology. 2008;109(1):81-87. doi:10.1097/ALN.0b013e31817881fc
  3. 9. Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology. 2001;95(6):1339-1345. doi:10.1097/00000542-200112000-00010
  4. 10. Ceylan G, Topal S, Atakul G, et al. Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients. Pediatr Pulmonol. 2021;56(9):3035-3043. doi:10.1002/ppul.25561
  5. 11. Buiteman-Kruizinga LA, Mkadmi HE, Schultz MJ, Tangkau PL, van der Heiden PLJ. Comparison of Mechanical Power During Adaptive Support Ventilation Versus Nonautomated Pressure-Controlled Ventilation-A Pilot Study. Crit Care Explor. 2021;3(2):e0335. Published 2021 Feb 15. doi:10.1097/CCE.0000000000000335

脚注

 

Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?

Authors: Demet Sulemanji, Andrew Marchese, Paul Garbarini, Marc Wysocki, Robert M Kacmarek

Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management.

Authors: Alexander H Petter, René L Chioléro, Tiziano Cassina, Pierre-Guy Chassot, Xavier M Müller, Jean-Pierre Revelly

Continuous use of an adaptive lung ventilation controller in critically ill patients in a multi-disciplinary intensive care unit

Authors: D Linton, J Brunner, T Laubscher

Correlation between the %MinVol setting and work of breathing during adaptive support ventilation in patients with respiratory failure.

Authors: Chin-Pyng Wu, Hen-I Lin, Wann-Chern Perng, Shih-Hsing Yang, Chien-Wen Chen, Yuh-Chin T Huang, Kun-Lun Huang

Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support.

Authors: Didier Tassaux, Eric Dalmas, Pierre Gratadour, Philippe Jolliet

Effects of implementing adaptive support ventilation in a medical intensive care unit.

Authors: Chien-Wen Chen, Chin-Pyng Wu, Yu-Ling Dai, Wann-Cherng Perng, Chih-Feng Chian, Wen-Lin Su, Yuh-Chin T Huang

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial.

Authors: C Kirakli, I Ozdemir, Z Z Ucar, P Cimen, S Kepil, S A Ozkan

Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery.

Authors: Pascale C Gruber, Charles D Gomersall, Patricia Leung, Gavin M Joynt, Siu Keung Ng, Ka-Man Ho, Malcolm J Underwood

Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study.

Authors: C F Sulzer, R Chioléro, P G Chassot, X M Mueller, J P Revelly

Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients.

Authors: Gokhan Ceylan, Sevgi Topal, Gulhan Atakul, Mustafa Colak, Ekin Soydan, Ozlem Sandal, Ferhat Sari, Hasan Ağın

Comparison of Mechanical Power During Adaptive Support Ventilation Versus Nonautomated Pressure-Controlled Ventilation-A Pilot Study.

Authors: Laura A Buiteman-Kruizinga, Hassan E Mkadmi, Marcus J Schultz, Peter L Tangkau, Pim L J van der Heiden