ASV, a form of closed loop ventilation, utilizes a pressure-targeted approach to optimize the balance between tidal volume and respiratory frequency based on Otis-predicted lung mechanics. By adopting a pressure ventilation format, ASV establishes a ventilatory pattern that minimizes the work of breathing, auto PEEP, and peak airway pressure. Although ASV shares similarities in gas delivery format with pressure control ventilation and pressure-regulated volume control, it stands out with its algorithmic control of the ventilatory pattern. ASV automatically determines the ideal tidal volume and respiratory rate to ensure that peak pressure remains below the target level.

Adaptive support ventilation (ASV) utilizes a pressure-targeted approach to closed loop ventilation. This approach optimizes the balance between tidal volume and respiratory frequency based on lung mechanics predicted by Otis. ASV adopts a pressure ventilation format, which establishes a ventilatory pattern that minimizes the work of breathing, auto positive end expiratory pressure (PEEP), and peak airway pressure. The gas delivery format of ASV is similar to pressure control ventilation and pressure-regulated volume control. However, ASV differs from these methods by incorporating algorithmic control of the ventilatory pattern. ASV automatically determines the ideal tidal volume and respiratory rate to maintain peak pressure below the target level.

Airway pressure release ventilation (APRV) is a mode of mechanical ventilation that is often used as an alternative or rescue strategy for patients with acute respiratory distress syndrome (ARDS) and hypoxemia that is unresponsive to conventional mechanical ventilation. However, APRV's effectiveness and appropriate use are still unclear due to the lack of consensus among practitioners, variability in the method of its application, and insufficient convincing evidence. Airway pressure release ventilation (APRV) is a mode of mechanical ventilation that involves the application of two levels of continuous positive airway pressure (CPAP) with the addition of a brief release phase. This brief release phase serves to allow for passive exhalation and can help to prevent overdistention of the lungs. The principles of APRV involve using a prolonged inspiratory phase at a high continuous positive airway pressure (CPAP) level, followed by a shorter expiratory phase at a lower CPAP level. This approach aims to improve gas exchange by maintaining alveolar recruitment and avoiding repetitive alveolar collapse and re-expansion. The settings for APRV involve adjusting the duration of the high-pressure phase (Phigh), the duration of the low-pressure phase (Plow), the duration of the release phase, and the pressure levels in both phases. The optimal settings for APRV can vary depending on the patient's individual respiratory mechanics and pathophysiology. Adjustment of APRV involves monitoring the patient's response to therapy and making appropriate changes to the settings to optimize ventilation and oxygenation. This may involve increasing or decreasing the duration or pressure of the Phigh and Plow phases, adjusting the CPAP levels, or changing the release phase duration. Overall, APRV is a complex mode of mechanical ventilation that requires careful adjustment and monitoring to optimize patient outcomes. This video will provide a detailed overview of the principles, settings, and adjustment of APRV to help healthcare practitioners effectively use this mode of ventilation for patients with respiratory distress.