Adaptive Support Ventilation: Set it & forget it?

http://blog.poplabs.com/2008/07/set-it-and-forget-it-why-roncos-showtime-rotisserie-cant-run-your-marketing-campaign/

I once mentioned in a previous posting (Adaptive Support Ventilation: the Pareto Principle of Mechanical Ventilation) that “ASV requires little operator input and provides substantial benefits”. However this does not mean “set it & forget”, a phrase I  over-heard from an ASV in-service.

 This is not a Ronco Rotisserie Oven ® this is a mechanical ventilator and the operator needs to be engaged and assess patient-ventilator interaction.

Here are some areas of focus:

1. Percent Minute Ventilation Setting: the operator needs to continually asses patient changes in minute ventilation demand.
1. To appropriately off-load the work of breathing.
2. To assure that the patient is not over-ventilated.
3. One can adjust the percent minute ventilation setting based on the “ASV target point”.

2. Trigger Setting: the trigger setting for spontaneous breaths needs to be appropriate set to prevent trigger asynchronies.

-Inspiratory time delay

-Ineffective efforts

-Auto-triggering

3. Pressurization rate (aka. Rise time): a appropriate pressurization rate is needed to prevent patient discomfort (too fast) and decrease inspiratory work (too slow).

4. Dynamic Lung: a quick & easy tool for monitoring changes in the patients pulmonary mechanics, EtCO2, and spontaneous activity..

5. Vent Status: the Vent Status tool is a nice feature to quickly determine if the patient is ready for liberation from mechanical ventilation. 

6. ETS Setting (Expiratory Trigger Sensitivity): a inappropriate ETS setting may lead to "Premature Cycling" or "Delayed Cycling". 

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