Advanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare).
New modes of mechanical ventilation with advanced closed loops are now available, and in the future these could assume a greater role in supporting critically ill patients in intensive care units (ICUs) for several reasons. Two modes of ventilation--proportional assist ventilation and neurally adjusted ventilatory assist--deliver assisted ventilation proportional to the patient's effort, improving patient-ventilator synchrony. Also, a few systems that automate the medical reasoning with advanced closed-loops, such as SmartCare and adaptive support ventilation, have the potential to improve knowledge transfer by continuously implementing automated protocols. Moreover, they may improve patient-ventilator interactions and outcomes, and provide a partial solution to the forecast clinician shortages by reducing ICU-related costs, time spent on mechanical ventilation, and staff workload. Preliminary studies are promising, and initial systems are currently being refined with increasing clinical experience. A new era of mechanical ventilation should emerge with these systems.
Lellouche
François
F
Institut Universitaire de Cardiologie et de Pneumologie de l'Hôpital Laval, Centre de Recherche de l'Hôpital Laval, 2725, chemin Sainte-Foy, G1V4G5, Québec, QC, Canada. francois.lellouche@crhl.ulaval.ca
Brochard
Laurent
L
D000465:Algorithms; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods / Q000639:trends; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy; D015656:Respiratory Mechanics; D013813:Therapy, Computer-Assisted; D015300:Ventilator Weaning / Q000379:methods