Adaptive Dynamic Subtidal Volume Ventilation (ADSV) Technology: Fluid Dynamic Principles and Physiologic Rationale for Personalized Treatment of Acute Respiratory Distress Syndrome
- 1SUNY Polytechnic Institute, Department of Civil and Mechanical Engineering, Utica, NY 13502, USA
- 2Independent Researcher, 1090 Brussels, Belgium
- 3SUNY Upstate Medical University, Department of Surgery, Syracuse, NY 13210, USA
Abstract
Acute respiratory distress syndrome (ARDS) imposes regionally heterogeneous, time-dependent alterations in pulmonary mechanics that fundamentally limit conventional ventilation strategies. Fixed-parameter approaches targeting global pressure, volume, or timing thresholds cannot simultaneously address the competing demands of alveolar recruitment and volutrauma prevention, nor can they adapt dynamically to the wide regional variation in compliance, resistance, and expiratory time constants that characterizes the injured lung. These limitations persist across volume-controlled, pressure-controlled, high-frequency oscillatory, and time-controlled ventilation strategies. This article provides a clinically oriented narrative review of the physiologic and fluid-dynamic principles underlying Adaptive Dynamic Subtidal Ventilation (ADSV), an emerging ventilation technology that incorporates a proximal airway device—the Sliding Venturi—that passively modulates subtidal gas delivery in response to evolving respiratory system mechanics. The device utilizes the Bernoulli and Venturi effects to establish a passive pressure–flow feedback mechanism in which downstream respiratory system mechanics influence gas entrainment, delivered subtidal volume, and airway pressure. In the low-compliance (high-elastance) ARDS lung, this may limit gas entrainment and subtidal volume delivery while maintaining distending pressure. As compliance improves, entrainment may increase, permitting larger subtidal volumes at lower pressures. This self-regulating behavior operates on millisecond timescales and adapts to changes in overall respiratory system mechanics. Patient-proximal placement facilitates rapid expiratory venting, potentially reducing circuit-related expiratory resistance and dynamic hyperinflation, although these effects require experimental validation. ADSV therefore provides a fluid-dynamic framework for mechanically responsive subtidal ventilation that may help manage the changing respiratory mechanics associated with ARDS. Bench and computational studies, followed by preclinical and clinical investigations, are needed to characterize device performance, evaluate regional physiological effects, and establish safety and efficacy in ARDS.
Related
- Monitoring multiple rib fractures using pulmonary electrical impedance tomography technology: correlation analysis of pulmonary ventilation changes
- Nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as initial respiratory support during minimally invasive surfactant therapy in preterm infants with respiratory distress syndrome: a retrospective real-world cohort study
- Global Protective Ventilator Settings Are Not Regional Protection: A Compartment-Resolved Framework for Personalizing Mechanical Ventilation in Acute Respiratory Distress Syndrome
- Combined Approach with Ultrasound and Pressure–Volume Loops to Manage Mechanical Ventilation in Acute Hypoxemic Respiratory Failure
- The impact of ventilation mode on systemic inflammation and organ dysfunction in a porcine model of abdominal sepsis-associated acute respiratory distress syndrome
BibTeX
@article{sekaran2026adaptive,
title = {{Adaptive Dynamic Subtidal Volume Ventilation (ADSV) Technology: Fluid Dynamic Principles and Physiologic Rationale for Personalized Treatment of Acute Respiratory Distress Syndrome}},
author = {Aarthi Sekaran and Adel Bougatef and Gary Nieman},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218714},
url = {https://www.mdpi.com/2077-0383/15/21/8714},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adaptive Dynamic Subtidal Volume Ventilation (ADSV) Technology: Fluid Dynamic Principles and Physiologic Rationale for Personalized Treatment of Acute Respiratory Distress Syndrome
AU - Aarthi Sekaran
AU - Adel Bougatef
AU - Gary Nieman
PY - 2026
DA - 2026/11/08
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218714
UR - https://www.mdpi.com/2077-0383/15/21/8714
AB - Acute respiratory distress syndrome (ARDS) imposes regionally heterogeneous, time-dependent alterations in pulmonary mechanics that fundamentally limit conventional ventilation strategies. Fixed-parameter approaches targeting global pressure, volume, or timing thresholds cannot simultaneously address the competing demands of alveolar recruitment and volutrauma prevention, nor can they adapt dynamically to the wide regional variation in compliance, resistance, and expiratory time constants that characterizes the injured lung. These limitations persist across volume-controlled, pressure-controlled, high-frequency oscillatory, and time-controlled ventilation strategies. This article provides a clinically oriented narrative review of the physiologic and fluid-dynamic principles underlying Adaptive Dynamic Subtidal Ventilation (ADSV), an emerging ventilation technology that incorporates a proximal airway device—the Sliding Venturi—that passively modulates subtidal gas delivery in response to evolving respiratory system mechanics. The device utilizes the Bernoulli and Venturi effects to establish a passive pressure–flow feedback mechanism in which downstream respiratory system mechanics influence gas entrainment, delivered subtidal volume, and airway pressure. In the low-compliance (high-elastance) ARDS lung, this may limit gas entrainment and subtidal volume delivery while maintaining distending pressure. As compliance improves, entrainment may increase, permitting larger subtidal volumes at lower pressures. This self-regulating behavior operates on millisecond timescales and adapts to changes in overall respiratory system mechanics. Patient-proximal placement facilitates rapid expiratory venting, potentially reducing circuit-related expiratory resistance and dynamic hyperinflation, although these effects require experimental validation. ADSV therefore provides a fluid-dynamic framework for mechanically responsive subtidal ventilation that may help manage the changing respiratory mechanics associated with ARDS. Bench and computational studies, followed by preclinical and clinical investigations, are needed to characterize device performance, evaluate regional physiological effects, and establish safety and efficacy in ARDS.
SN - 2077-0383
ER -