title: Adaptive support and pressure support ventilation behavior in response to increased ventilatory demand.
abstract: BACKGROUND
  Dual-control modes of ventilation adapt the pressure delivery to keep a volume target in response to changes in respiratory mechanics, but they may respond poorly to changes in ventilatory demand. Adaptive support ventilation (ASV), a complex minute volume-targeted pressure-regulated ventilation, was compared to adaptive pressure ventilation (APV), a dual-mode in which the pressure level is adjusted to deliver a preset tidal volume, and to pressure support ventilation (PSV) when facing an increase in ventilatory demand.
  
  
  METHODS
  A total of 14 intensive care unit patients being weaned off mechanical ventilation were included in this randomized crossover study. The effect of adding a heat-and-moisture exchanger to augment circuit dead space was assessed with a same fixed level of ASV, PSV, and APV.
  
  
  RESULTS
  Arterial blood gases, ventilator response, and patient respiratory effort parameters were evaluated at the end of the six periods. Adding dead space significantly increased minute ventilation and PaCO2 values with the three modes. Indexes of respiratory effort (pressure-time index of respiratory muscles and work of breathing) increased with all ventilatory modes after dead-space augmentation. This increase was significantly greater with APV than with PSV or ASV (P < 0.05). The assistance delivered during APV decreased significantly with dead-space from 12.7 +/- 2.6 to 6.7 +/- 1.4 cm H2O, whereas no change occurred with ASV and PSV.
  
  
  CONCLUSIONS
  ASV and PSV behaved differently but ended up with similar pressure level facing acute changes in ventilatory demand, by contrast to APV (a simple volume-guaranteed pressure-control mode), in which an increase in ventilatory demand results in a decrease in the pressure support provided by the ventilator.
authors.affiliation: Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Equipe soutenue par la Région et l'Institut National de la Santé et de la Recherche Médicale 25, Université Montpellier 1, Montpellier, France. s-jaber@chu-montpellier.fr
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sebbane
authors.forename: Daniel
authors.initials: D
authors.lastname: Verzilli
authors.forename: Stefan
authors.initials: S
authors.lastname: Matecki
authors.forename: Marc
authors.initials: M
authors.lastname: Wysocki
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Eledjam
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000368:Aged; D018592:Cross-Over Studies; D006801:Humans; D001239:Inhalation / Q000502:physiology; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D015656:Respiratory Mechanics / Q000502:physiology*