Novel Ramp Test to Optimize Pressure Setting of Adaptive Servo-Ventilation Using Non-Invasive Lung Fluid Level...

Area of Science:

• Cardiology
• Pulmonology
• Medical Devices

Background:

• Establishing optimal patient selection and device pressure settings is crucial for successful adaptive servo-ventilation (ASV) therapy.
• Inappropriately high ASV pressures in non-congested patients can reduce cardiac output and worsen outcomes.
• Remote dielectric sensing (ReDS) offers a noninvasive method to assess lung fluid levels, potentially aiding ASV optimization.

Observation:

• A case report details an 83-year-old woman with acute decompensated heart failure with preserved ejection fraction.
• Significant pulmonary congestion was identified using ReDS (47% value).
• A ramp test was conducted, adjusting ASV pressure while monitoring ReDS values and estimating cardiac output/stroke volume.

Findings:

• The ASV pressure setting was optimized to simultaneously minimize pulmonary congestion and maximize cardiac output.
• Following therapy with the optimized ASV settings, the patient experienced an uneventful hospitalization and was discharged.

Implications:

• A customized ramp test utilizing ReDS technology is proposed for optimizing individual ASV pressure settings.
• This approach may offer an alternative to default or potentially excessive pressure settings.
• Further large-scale studies are needed to validate the prognostic impact of this customized ramp test protocol.