Adaptive Support Ventilation (ASV) is a specialized ventilation mode designed for intubated patients, providing a combination of pressure-controlled and volume-targeted support to optimize patient outcomes. It automatically adjusts to patient needs, requiring minimal user intervention while promoting weaning and reducing ventilation times. The mode's safety and effectiveness have made it a preferred choice for managing diverse patient groups, including those with COPD and ARDS.

1. ADAPTIVE SUPPORT
VENTILATION
Aziza Al-Amri
Mashail Al-Rayes

2. • Introduction
• Indication
• How does this mode work ?
• Initial setting
• Advantages and Disadvantages
• Weaning

3. Introduction
Adaptive Support Ventilation (ASV) is an easy-to-use and
extremely safe ventilation solution for the respiratory
management of your intubated patients.
ASV is unique to HAMILTON MEDICAL ventilators, a
standard on every platform and since 1998 successfully on the
market.
ASV has been successfully used in a variety of patient groups
including post-operative, COPD, and ARDS patients.

4. ASV mode
A dual control mode that uses both PC and PS to maintain a set
minimum VE using the least required setting for minimal WOB
depending on the patient’s condition and effort .
It could provides mandatory, assisted or spontaneous types of
breath .
Breath type Trigger Limit Cycle
Mandatory Time Pressure Time
supported Patient Pressure Flow

5. Indications
For patients needing full or partial ventilatory support .
Patients requiring a lowest possible PIP and a guaranteed Vt .
 ALI/ARDS .
Patients with the possibility of work land changes
(CL and Raw) .
Facilitates weaning .

6. How does it
work ?

7. Passive Vs. Active patient
ASV in passive patients :
ASV is a volume-targeted pressure controlled mode with
automatic adjustment of inspiratory pressure, respiratory rate, and
inspiratory/expiratory time ratio. Maximum tidal volume is
controlled by setting a maximum inspiratory pressure. Expiratory
time is determined according to the expiratory time constant in
order to prevent dynamic hyperinflation.

8. ASV in active patients ( spontaneously breathing
patients ) :
ASV is a volume-targeted pressure support mode with automatic
adjustment of pressure support according to the spontaneous
respiratory rate. The automatic decrease of pressure support when
the patient recovers their inspiratory strength is very useful for
weaning. ASV can also be used to perform a weaning trial before
extubation.
Passive Vs. Active patient

9.  Enters the patient’s IBW  VE % ( VT , RR ) .
 A series of test breaths measures the system C,
resistance and auto-PEEP .
 Expiratory time constant .
 If no spontaneous effort occur, the ventilator
determines the the appropriate F , VT .
 I:E ratio and Ti of the mandatory breaths are
continually being “optimized” by the ventilator to
prevent auto-PEEP .
1 number
How does it work ?

10.  If the patient starts having inspiratory effort, the
number of mandatory breaths and the ventilator
switches to PS .
 Pressure limits for both mandatory and spontaneous
breaths is always being automatically adjusted .
 The more the spontaneous (PS) breathing, the less
the mandatory (PC) breaths .
How does it work ?

18. ASV graph

19. Dynamic Lung

20. ASV technology is an outstanding ventilation solution that
assures a combination of :
Ease of use
Efficiency
through
innovation
Improve patient
outcome

21. Ease of use
It requires that you set very few controls and the
intelligence of ASV does the rest.
ASV contributes through simple yet intelligent interfaces to
shorter training periods and improved staff utilization
Unlike conventional modes which require you to set many
parameters .
ASV requires attention to just ( minute ventilation )

22. Adaptive technology for everyday use
Patients’ lung mechanics change constantly during ventilation.
Clinicians however, don’t always have the time to monitor and
adjust settings for each patient minute by minute and hour by
hour. ASV helps by adapting to the changing conditions and
needs of each patient .
ASV delivers the optimal tidal volume safely at the lowest
pressure possible, combining the benefits of pressure-
controlled ventilation with a volume guarantee .

23. ASV technology is an outstanding ventilation solution that
assures a combination of :
Ease of use
Efficiency
through
innovation
Improve patient
outcome

24. Improved patient outcome
 Intelligent Ventilation with ASV means fewer days on the ventilator .
 Clinicians can spend more time with the patient and ensure shorter
stays in the ICU.
 ASV employs lung protective strategies to minimize complications
from Auto-PEEP and volutrauma/barotrauma. ASV also prevents
apnea, tachypnea, excessive dead space ventilation and excessively
large breaths.

25. IS IT SAFE ???

26. Yes , It is ..
ASV is an extremely safe ventilation solution for the
respiratory management of your intubated patients. It employs
lung-protective rules and adjusts the ventilatory pattern based
on the patient’s pulmonary mechanics and spontaneous
respiratory activity to maintain preset minute ventilation .
ASV guides the patient in a favorable breathing pattern from
fully supported ventilation to extubation.

27. ASV technology is an outstanding ventilation solution that
assures a combination of :
Efficiency
through
innovation
Improve patient
outcome

28. Efficiency through innovation
The unique closed-loop ventilation system ASV automatically
promotes spontaneous breathing for patients in all ventilation
modes and phases.
 It encourages spontaneous activity from the start of ventilation
and promotes weaning from first deployment .
Results: a shorter length of ventilation and a shorter weaning time
.

29. There are a lot of studies that showed that ASV :
Can be used to ventilate virtually all intubated patients ( active
/ passive ) .
 requires less user interaction, adapts to the patient's breathing
activity more frequently and causes fewer alarms .
 adapts to changes in the patient’s lung mechanics over time .
 allows shorter weaning times .
allows shorter ventilation times .
ASV adapts to lung mechanics by automatically
applying lower tidal volumes in ARDS patients

30. Advantages Disadvantages and Risks
Guaranteed VT and VE Inability to recognize and adjust to Δ
in alveolar VD
Minimal patient WOB Possible respiratory atrophy
Breath by breath analysis A sudden ↑ in RR and demand may
result in a ↓ in ventilator support
Ventilator adapts to the patient Varying mean Paw
Weaning is done automatically and
continuously
In patients with COPD, a longer TE
may be required
Decelerating flow waveform for
improved gas distribution

31. Weaning
1. Check the PS level used with the patient with the set VE
( PS = PIP – PEEP )
2. Start to wean by decreasing VE by 20% , PS will decrease.
3. Decrease FiO2 to 40% or less.
4. When the PS < 16 , start spontaneous breathing trial.

32. Spontaneous breathing trial
1. Decrease the VE to the minimum percentage (25%).
2. Decrease the PEEP to 5 .
3. Monitor the patient (30 min – 2 H)
4. If the patient is fine and stable (no signs of distress).
5. Extubate.

33. Question
 1. Many authors called ASV as the “no mode” or
“three in one way’’ , why do you think so ?
 2. Explain how can ASV combines various
ventilatory modes .

34. References
Ventilator management ( Dana Oakes ) .
Hamilton : https://www.hamilton-
medical.com/Solutions/Adaptive-Support-Ventilation-ASV.html
ASV for faster weaning in COPD:
http://www.ncbi.nlm.nih.gov/pubmed/21406514
Http://www.ardsnet.org/

35. Thank you