Low Integrated Area of Desaturation Index after ASV Therapy is Strong Indicator to Predict Cardiovascular Events in Heart Failure Patients

ASV (Adaptive-Servo Ventilator) is recognized as one of the effective option for treatment of heart failure, such as repeat readmission in treatment-resistant. In heart failure patients it is said that the Frank-Starling curve is improved by the adequate PEEP by ASV. However excessive PEEP leads to decrease in stroke volume (SV). It has been difficult to determine the value of the adequate PEEP in the clinical up to the present. To patient who introduced the ASV in our hospital, PEEP is raised adequate from 2cmH2O to 15cmH2O to assess the SV using AESCULON mini is a non-invasive cardiac output monitor. We will report on two cases which introduced ASV in heart failure due to ischemic heart disease. First case showed SV 48ml/CI 1.9L/min/m without using ASV, SV 53ml/CI 2.0 L/min/m in PEEP 5cmH2O, SV 63ml/CI 2.3 L/min/m in PEEP13cmH2O. It obtained the elevation of SV in PEEP 13cmH2O. Second case showed SV 60ml/CI 2.6 L/min/m 2 without using ASV, SV 55ml/CI 2.5 L/min/m in PEEP5cmH2O, SV 51ml/CI 2.3 L/min/m 2 in PEEP15cmH2O. Excessive PEEP leads to decrease in SV. PEEP is being fixed to 5cmH2O in the initial state of ASV. In many cases, it has been used without changing the settings. It may be important to adjust the PEEP setting for each case and condition.