CHEST Guidelines-Adaptive-Support-Ventilation-From-Intubation-to-Ex

Adaptive-Support-Ventilation-From-Intubation-to-Ex

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The document discusses a randomized controlled trial (RCT) by Kirakli et al., assessing adaptive support ventilation (ASV) against pressure assist/control ventilation (P-ACV) for mechanical ventilation (MV) in ICU patients. The study indicated shorter weaning and total MV durations in the ASV group. However, the authors of the letter raise concerns about the study design and outcomes. They point out that prior research supported ASV benefits during weaning, yet this study uniquely evaluated ASV throughout the entire MV period. A critical point of contention was the absence of pressure support ventilation (PSV) in the control arm after spontaneous breathing trial (SBT) failures, which might have skewed outcomes since PSV is favored post-SBT failure for improved patient-ventilator interaction. Notably, over half the patients having COPD were prone to asynchronies, but related data was not shown, possibly affecting results. The authors also highlight the lack of data on sedation differences between groups and the absence of a standardized fluid protocol to address common SBT failure causes.<br /><br />In response, the original study's authors thank Grieco et al. for their feedback and elaborate on methodological choices like using P-ACV in the control group due to its pressure-controlled features similar to ASV in passive patients. They argue that P-ACV can achieve adequate synchrony comparable to PSV. Additionally, the advantages of closed-loop systems, especially in ICUs with higher workloads, are highlighted. Both groups adhered to a similar weaning protocol, minimizing the potential biases around fluid management. Despite the limitations, the study suggests ASV might streamline ICU workflows, although results warrant cautious interpretation and further validation through multicenter studies.

Keywords

randomized controlled trial

adaptive support ventilation

pressure assist/control ventilation

mechanical ventilation

ICU patients

weaning duration

pressure support ventilation

spontaneous breathing trial

patient-ventilator interaction

closed-loop systems