CHEST Guidelines-Response_chest

Response_chest_28

Pdf Summary

In a letter to the editor, Dr. Cenk Kirakli and colleagues respond to comments on their study comparing adaptive support ventilation (ASV) and pressure assist/control ventilation (P-ACV) in ICU patients. They clarify that P-ACV was used as a control because ASV functions as a pressure-controlled mode in passive patients. Patients meeting the readiness criteria were immediately tested with a spontaneous breathing trial (SBT) using a T-tube. Failing patients received P-ACV, though pressure support ventilation (PSV) could also be selected. The group believes P-ACV, when set and adjusted carefully, can match the synchrony of PSV. They acknowledge the automatic switch to PSV in ASV could lead to better outcomes, especially in high-workload ICUs where recognizing a patient’s readiness for extubation can be delayed.<br /><br />The study couldn’t evaluate physiological data on patient-ventilator interaction due to technical limitations, which they suggest warrants further research. The communication also addresses sedation policies, noting minimal sedation was used. Similar fluid and nutrition protocols were applied to both the ASV and control groups, eliminating their impact on results. The authors suggest that while ASV could aid quicker weaning and extubation, clinical expertise remains essential, and they call for multicenter studies to validate their findings.<br /><br />Separately, Lucy Gibson and colleagues highlight the importance of a narrative approach in asthma care, echoing findings that patient experiences are often overlooked. They propose integrating community support and school programs to improve patient engagement and asthma management. Their results, from a peer-to-peer educational program in schools, show sustained improvements in asthma understanding and management among children. They advocate for this method, citing significant improvements and understanding demonstrated in their London-based educational initiatives.

Keywords

adaptive support ventilation

pressure assist/control ventilation

ICU patients

spontaneous breathing trial

patient-ventilator interaction

sedation policies

weaning and extubation

asthma care

peer-to-peer education

community support