Minute Ventilation ASV

ResMed's ASV

Clinically studied, ResMed's unique PaceWave is the only Adaptive Servo-Ventilation (ASV) therapy to target recent Minute Ventilation (MV), providing our most responsive therapy for easy, personalised and comfortable treatment of a wide range of central breathing disorders which are typically difficult to treat.

 

Streamlining titration and improving treatment efficacy, PaceWave is able to adapt automatically to treat both obstructive and central events, and helps improve sleep quality in even the most difficult sleep disorders. It rapidly stabilises breathing to improve blood gases faster and reduce stress on the heart1.

 



How does PaceWave work?

PaceWave is the only ASV therapy to target the patient's own recent minute ventilation, continuously learning the patient’s individual breathing rhythm and instantly adapting and responding to changes in their breathing to deliver personalised therapy.

 

Building on ResMed's trusted ASV therapy, PaceWave now automatically treats upper airway obstruction with auto-adjusting EPAP (ASVAuto mode), while treating central breathing disorders with auto-adjusting pressure support.

 

PaceWave improves respiratory control, adapting pressure support to stabilise breathing and helps prevent over and under ventilation by treating hypopnea and helping prevent hyperpnea.

 

PaceWave personalises breathing by learning, responding, predicting and optimising with split-second resolution, to suit each patient’s own unique breathing pattern, so that treating patients on ASV therapy has never been easier.


 

PaceWave Learns

PaceWave learns continuously for personalised therapy

PaceWave learns your patient's breathing pattern and personalises their therapy as shifts occur during sleep. PaceWave is designed to work with and adapt to their changing metabolic demand throughout the night, through the various stages of sleep.

 

High-resolution learning

PaceWave measures the entire breath with split-second resolution, calculating the patient's ventilation to set relevant therapy targets even during partial obstructions.

 

Sets MV target to 90% of the patient's own ventilation

This enables PaceWave to reduce short-term oscillations in breathing, while maintaining stability and allowing ventilation to vary with the patient's metabolic demand. By doing this, PaceWave avoids over-ventilating the patient.

 

Constantly updates targets

Central breathing disorders are caused by a lack of drive to breathe. They have also been linked with CSA exacerbated by sighs or body position and rostral fluid displaced from the legs towards the neck and lungs.

 

PaceWave therapy continually adjusts targets to reflect changes in your patient's ventilation and their changing needs during the night and through various sleep stages.

 

PaceWave: the only ASV Technology to target the patient's own recent MV.

 


 

PaceWave Responds

PaceWave responds rapidly for effective therapy

PaceWave responds breath by breath. It stabilises breathing and reduces disruption during the night by significantly decreasing the arousal index, decreasing the number and length of apnoeas and hypopnoeas, and increasing mean oxygen saturation2.

 

Maintains targets and stabilises natural breathing by automatically adjusting pressure support

PaceWave constantly measures the patient's MV to determine how far the patient is from their target. It auto-adjusts the pressure support, increasing and decreasing in relation to this distance. PaceWave responds within one breath to bring the patient closer to their own ventilation need.

 

Stabilises the upper airway

If the upper airway is closed, no matter how advanced the algorithm is, it cannot stabilise ventilation. PaceWave offers the choice of two modes. In ASV mode, the EPAP can be manually titrated to set the optimal fixed EPAP to keep the upper airway open. In ASVAuto mode, the technology responds to obstructive events including flow limitation, snore and apnoea, to automatically maintain an open airway.

 


 

PaceWave Predicts

PaceWave predicts each patient's unique needs for ease-of-care

Using MV targets, PaceWave works with the dynamic nature of breathing, allowing for longer expiratory pauses and sighs.

 

Mapping each breath against a series of set points

PaceWave examines the features of the patient’s flow and by comparing these with a large number of predefined points within the breath, it can determine exactly where the patient is within the current breath.

 

Predicting inspiratory and expiratory time

By observing the rate at which the patient progresses through each breath, PaceWave forms dynamically updated estimates of the lengths of inspiration and expiration and from this calculates the current respiratory rate.

 

Tracking the position of the patient within the breath, enables the delivered pressure to reach its therapy peak and nadir continuously and smoothly in sync with the patient's own breathing.

 

Supporting the patient’s breathing

By continuously learning the patient’s own respiratory rate, PaceWave provides breaths in sync with the patient’s own breathing when their effort decreases. This quick response minimises the length of time that the patient is without support. When the patient deviates too far from their target, PaceWave aims to stabilise the patient by adjusting pressure support. If necessary, it will move the respiratory rate gently towards a target of 15 bpm.

 

PaceWave: treating challenging patients has never been easier.

 


 

PaceWave Optimises

PaceWave optimises comfort and synchrony for compliance

Patient comfort is the underlying goal for PaceWave. Offering more support when it's needed and less when it's not, along with ResMed's unique pressure waveform, PaceWave aids natural breathing comfort. The advanced leak management helps maintain synchrony between the therapy and the patient’s own breathing rhythm.

 

Support when it’s needed

A wider auto-adjusting Pressure Support range with Pressure Support varying from 0-20 cm H2O.

 

Natural breathing comfort

PaceWave, with ResMed’s unique pressure waveform, helps the patient ease into therapy. PaceWave delivers a smoother, more natural breathing experience by replicating the wave shape of normal breathing.

 

Let your patients chose the way in which they fall asleep

PaceWave’s enhanced features make it gentle for even the most challenging patients to ease into therapy.

 

As the amount of daytime sleepiness varies in central breathing disorders, often patients are not already sleepy and may find it difficult to fall asleep. The ramp functionality in ASV modes can help your patient fall asleep easily by making it more comfortable to breath as they transition from wake to sleep states.

 

Maintains comfort even while stabilising the upper airway

The automatically adjusting EPAP feature of PaceWave’s ASVAuto mode aims to stabilise the upper airway at the lowest required EPAP. That is, the EPAP increases when there are signs of unstable breathing and decreases during times of stable breathing. As breathing normalises, the EPAP gradually decreases towards the minimum EPAP setting for comfort, over a 20 to 40 minute period, depending on the type of obstructive event that has occurred.

 

PaceWave;

  • learns the patient’s own breathing and sets ventilation targets accordingly
  • responds instantaneously within the breath, adjusting Pressure Support to stabilise breathing
  • stabilises the upper airway by adjusting EPAP when needed
  • maintains synchrony by predicting inspiratory and expiratory phases, as well as expiratory pauses
  • provides greater comfort essential for compliance

PaceWave, ResMed’s most advanced ASV technology


Central Breathing Disorders

ResMed's ASV technology is the most studied treatment for central breathing disorders including Cheyne-Stokes respiration (CSR), periodic breathing and central and/or mixed apnoea. It has been the subject of more published papers than any other therapy and used for over 10 years to treat patients with these conditions.

 

Building on this proven technology and now with ASVAuto mode, ResMed's PaceWave technology takes ASV therapy to the next level.

 

Patient conditions

 

Clinically studied algorithm with demonstrated results across the spectrum of central breathing disorders. These include:

  • Periodic breathing disorders such as Cheyne-Stokes Respiration (CSR ) associated with Heart Failure (HF)3 (normocapnic and hypocapnic),
  • Other forms of central and concomitant obstructive events4
  • Complex Sleep Apnoea (CompSA)5

 

Therapy benefits

ASV has been shown to improve sleep quality2, increase REM sleep3,6, increase slow wave sleep5, and reduce respiratory arousals3.

 

Clinical References

  1. Hastings, P.C., et al., Adaptive servo-ventilation in heart failure patients with sleep apnea: a real world study. Int J Cardiol, 2010. 139(1): p. 17-24.
  2. Oldenburg O, Bitter T, Prib N, Lohse M, Koerber B, Fischbach T, Schmidt A, Horstkotte D. Performance of adaptive servoventilation and enhanced adaptive servoventilation in heart failure patients with central sleep apnea. Sleep 2012;35 (Suppl):A176
  3. Oldenburg, O., et al., Adaptive servo-ventilation improves cardiac function and respiratory stability. Clin Res Cardiol, 2011. 100(2): p. 107-15.
  4. Allam, J.S., et al., Efficacy of adaptive servo-ventilation in treatment of complex and central sleep apnea syndromes. Chest, 2007. 132(6): p. 1839-46.
  5. Morgenthaler, T.I., et al., Adaptive servo-ventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes. Sleep, 2007. 30(4): p. 468-75.
  6. Pepperell, J.C., et al., A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure. Am J Respir Crit Care Med, 2003. 168(9): p. 1109-14.
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