ACM mode

Renata Pitscheneder
Product Specialist
 Overview

• Auto Control Mode (ACM) is a positive pressure mode of mechanical ventilation

that is closed loop controlled and provides a seamless automatic transition
between controlled ventilation (PRVC-CMV) to spontaneous ventilation (PRVC-PS)
based on the patient requirements.
• Pressure-regulated volume control (PRVC) is a mode of ventilation in which the
ventilator attempts to achieve set tidal volume at lowest possible airway
pressure. 
• The transition from PRVC-CMV to PRVC-PS only takes place after a successful
Trigger Trial (explained later)
 Autocontrol Inputs
Autocontrol inputs (information the ventilator uses to react):
• Patient’s respiratory rate: When the patient is in PRVC-CMV mode, the ventilator monitors the amount of
trigger that the patient is doing. When the patient is in PRVC-PS the ventilator monitors the spontaneous
rate of the patient.
• Patient’s tidal volume: ventilator measures the exhalated tidal volume of the patient and calculates the
difference to the target volume. This difference would vary the level of inspiratory pressure according to
the PRVC mode.
• Patient’s inspiratory pressure: the level of the inspiratory pressure would change based on the patient’s
clinical conditions. In order to keep the patient in a safe zone of inspiratory pressure, there is only a
restricted area to change the level of pressure following the PRVC algorithm.
• Time: Auto Control measures several periods of time in order to modify the parameters and take decisions.
• CMV Hold: time period the patient stays in CMV. A Trigger Trial will begin when it elapses.
• ATT break time: time period the Trigger Trials will be suspended after a failed trial.
• Apnea: Maximum apnea time acceptable during ventilation.
 

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 Autocontrol outputs

Autocontrol outputs (changes made by the ventilator):

• Mode of ventilation: based on the inputs mentioned before, the ventilator would change modes
of ventilation. Initially would begin with PRVC-CMV. If the clinical condition of the patient
improves then the mode could change from PRVC-CMV to PRVC-PS. Of course, if the patient is in
PRCV-PS and the patient cannot keep the ventilation targets (Ve or Vt), then the ventilator would
change from PRVC-PS to PRVC-CMV. The algorithm would take into consideration all the inputs to
change the mode of ventilation.
• Inspiratory pressure: since ACM would change from PRVC-CMV to PRVC-PS and vice versa if the
patient needs more support, the level of pressure would change every breath trying to get the
lowest level of pressure that allows the volume target.

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 ACM mode selections
• Vt assured: When Vt assured is selected the ventilator would try to wean the patient
keeping the Vt at target. Vt is one of the settings of the mode.

• Ve assured: When Ve assured is selected, the ventilator would try to wean the patient
keeping the minute volume at target. User sets the Ve (minute volume) as part of the
setting. Then based on the set rate the ventilator would get the current Vt target.

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 Trigger Trial
Trigger trial is the process when the ventilator slowly reduces the mandatory
support and monitors the total breathing rate and the minute volume of the
patient. If the patient can keep the total breathing rate and the minute volume
within a set range, then the ventilator would change modes. If Trigger Trial fails,
patient stays in CMV mode.
Conditions to initiate Trigger Trial:
• In case Trigger Trial button is pressed
• In case ATT is in an active period and the ventilator detects at least one
spontaneous trigger in each of the 3 consecutive minutes in CMV mode
• In case CMV hold time elapsed and ATT is Off or Break Time elapsed.

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 ACM criteria
The criteria defines how ACM works according to a set of variables. One (standard criteria) has fixed
values while the other (advanced criteria) allows the user to set the variables involved in mode
changes. Based on this setting, the behavior of the ventilator will emulate the protocol that the user
would normally follow, however now it will work automatically.
Adaptive weaning criteria variables:
• Apnea: Maximum apnea time acceptable during ventilation. After this time elapses with no
spontaneous breaths, mode will change from PRVC-PS to PRVC-CMV. In standard criteria: 20
• Ppeak limit: Since PRVC modes deliver variable inspiratory pressure in order to achieve volume target,
this variable sets upper limit for inspiratory pressure. In standard criteria: 5 cmH2O below Ppeak
alarm setting.
• Low Ve%: In CMV mode the user sets a Ve, this variable is the lowest Ve% acceptable during PS mode.
In standard criteria: 70% of set Ve
• CMV hold: This is the time the patient would stay at CMV. When this time has elapsed, then the
ventilator will begin a trigger trial. In standard criteria: 0.5 hours
• Adaptive Trigger Trial: In case ATT is ON, the ventilator will monitor the activity of the patient. In case
the patient triggers breaths for 3 consecutive minutes in PRVC-CMV mode, then the ventilator will
begin to wean the patient. The trigger trials would be suspended for “Break time” in case the weaning
of the patient failed. The user could also set ATT break time at OFF. In this case if the patient would
stay at PRVC-CMV the time set at CMV hold. In standard criteria: 30 min

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 ACM monitor/statistics window
This window shows the relation between the rate and the volume. If the user selects Ve assured,
then the window would show a graphical representation of rate (b/min) vs Vt (ml). If the user
selects Vt assured, then this window would show the rate (b/min) vs Ve (l/min) relationship.
The green curve will show all the possible combinations of the set volume. In case Ve assured, the
green curve will show all the Rate * Vt that provides the requested Ve for that patient. The target
would be a certain point of that curve showed as a green ball. A yellow star will show on the
same window the patient’s rate and vt. If patient is breathing spontaneously (PRVC-PS) then Vt
and rate could vary constantly. The position of the star on this window would change based on
the current values of Vt and spontaneous rate of the patient.
Not all the combinations of rate and volume would be safe for the patient. Therefore, a light blue
rectangle is showed as the patient’s safe zone called lung protective zone.
The ACM statistics window will show how many trigger trials and mode changes were made in a
certain amount of time. Also there are 2 pies that show in grey the % of time on mandatory mode
(PRVC-CMV) and in yellow the % of time the patient was ventilated in spontaneous mode (PRVC-
PS).

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 SBT advisory message
When patient is in Auto Control and being ventilated with PRVC-PS, the ventilator will analyze if the
patient meets conditions to proceed with a SBT (Spontaneous Breathing Trial). If those conditions are
met, then the ventilator will activate the SBT advisory message.
SBT Advisory Conditions are:
• FiO2<=50 %
• PEEP<= 8 cmH2O
• PS<= 10 cmH2O
• Monitored Ve >= set Ve (Ve assured) or Monitored Vt >= set Vt (Vt assured)
• Set rate <+ total rate < High rate alarm
• Vt >= 5 ml/Kg IWB

“SBT advisory” message will appear with only one beep. It will disappear once user click off the green
bar. It will come back in 24 hours or when the Auto Control was restarted, whichever comes earlier

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ACM settings
Ve assured, Standard Criteria Vt assured, Standard Criteria

Ve assured, Advanced Criteria Vt assured, Advanced Criteria

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