Blog | Monday, October 24, 2016

Is adaptive servo ventilation still good for anything?


It wasn't much of a debate at the pro/con session at CHEST 2016 (which I'm in LA covering this week). Both speakers agreed that last year's SERVE-HF trial, published in the New England Journal of Medicine, was the end of adaptive servo ventilation (ASV) as a treatment for heart failure patients who have Cheyne-Stokes breathing. The treatment not only failed to improve patients' survival, it appeared to decrease it, leading the manufacturer to issue a field safety notice. The only question left is whether ASV might be useful for other purposes. Najib Ayas, MD, made the argument that patients with opioid-related central apnea and patients with complex apnea might still benefit from ASV. Especially among patients who are already on ASV, it can make sense to still use it (as long as they have normal ejection fraction), he argued. His debate opponent Harry Yaggi, MD, countered that treating the underlying causes of the apnea is really the way to go, and that there's not good data to support the use of ASV in these patients. You'll be totally shocked by the conclusion they agreed on--more research is needed to determine the best course of treatment!