Mise en place de la ventilation auto asservie

Adaptive servo-ventilation (ASV) is a novel therapy that provides inspiratory pressure support superimposed on fixed or automatic positive expiratory pressure. This inspiratory pressure is modified cycle by cycle according to the patient's ventilation. It was initially conceived to correct the Cheyne-Stokes respiration in patients with stable cardiac failure and receiving optimal medical treatment. Today, indications widened in eucapnic/hypocapnic sleep central apnea, even if the level of proof of its efficiency to normalize the apnea/hypopnea index is weaker. During the institution of an ASV or modifications of the pressures, HF patients, and it especially if the HF is severe, have to benefit from a clinical supervision and arteriel pressure monitoring. As any ventilation, the choice of the mask and the management of the leaks must be meticulous; the beginning pressures have to allow the best comfort. The modifications of the other parameters require a fine analysis of poly(somno) graphic data and software. The persistence of obstructive abnormalities will be managed by the increase of the expiratory pressure. For the central abnormalities, it is necessary to be patient. The modifications of the inspiratory pressure support limits and\or a modification of the back up rate can be proposed.