Response of Home-Use Adaptive Pressure Modes to Simulated Transient Hypoventilation.

Background: Adaptive servoventilation (ASV) is a recently developed ventilation mode designed to stabilize ventilation in patients with central sleep apnea and Cheyne-Stokes respiration. Alternatively, modes aiming to maintain average ventilation over several breaths, such as average volume-assured pressure support (AVAPS) and intelligent volume-assured pressure support (iVAPS), could be efficient during ventilation instability by reducing central events. These modes are available on a variety of devices. This bench evaluation studied the response of these different modes and devices to simulated transient hypoventilation events.
Methods: Three home ventilation devices operating in ASV modes (AirCurve S10 VAuto, ResMed; DreamStation autoSV, Philips; Prisma CR, Löwenstein) and 2 ventilators with the AVAPS mode (DreamStation BiPAP, Philips; Lumis iVAPS, ResMed) were evaluated during transient central hypopnea/hypoventilation simulations characterized by a constant breathing frequency of 15 breaths/min and a progressive decrease of tidal volume (V _T ) from 500 mL to 50 mL, in 18, 12, 9, and 6 breaths, respectively, followed by a progressive return to the baseline at the same rate.
Results: The AirCurve S10 VAuto reacted to a V _T decrease between 80% and 50% of baseline V _T . DreamStation BiPAP and Prisma CR reacted when V _T decreased to between 60% and 30% of baseline V _T , whereas the AVAPS response to hypopnea occurred during the crescendo phase of hypopnea/hypoventilation V _T . The iVAPS response was between that of the AirCurve S10 VAuto and the other ASV devices. Among the ASV devices, the minimum V _T was higher with AirCurve S10 VAuto, followed by the Prisma CR and the DreamStation BiPAP. Minimum V _T was not influenced by AVAPS and was improved by iVAPS without outperforming the AirCurve S10 VAuto. Maximum V _T was increased by iVAPS, whereas ASV devices did not induce a significant V _T overshoot.
Conclusions: ASV devices improved central hypopnea/hypoventilation events without inducing hyperpnea events and therefore were better adapted than AVAPS and iVAPS devices, with notable differences in their responses to hypoventilation events.
Competing Interests: The devices used in this study were donated by ASV Santé, which is a home care provider. The authors have disclosed no conflicts of interest.
(Copyright © 2020 by Daedalus Enterprises.)