Technological development in mechanical ventilation.
OBJECTIVE
Innovative modes of mechanical ventilation, mainly based on complex closed loop technologies, have been recently developed and are now available for clinical use.


RESULTS
Proportional assist ventilation with load-adjustable gain factors and neurally adjusted ventilatory assist are innovative modes of mechanical ventilation delivering a level of assistance proportional to the patient's effort, thus improving patient-ventilator synchrony and potentially representing a real clinical advantage. Adaptive support ventilation is a ventilatory mode delivering assisted (pressure support ventilation-like) or controlled breathing cycles (pressure-controlled-like), related to a minute ventilation target set by the clinician and on automated measurements of the patient's respiratory mechanics. Noisy pressure support ventilation, finally, is a recently described experimental evolution of pressure support, with some improvement potentials, but no clinical application till now.


CONCLUSIONS
The recently reported results with proportional assist ventilation with load-adjustable gain factors, neurally adjusted ventilatory assist, and adaptive support ventilation are, till now, mainly based on preliminary physiologic and clinical studies; although they seem to be promising, suggesting that closed loop-based modes could represent a real innovation in the field of mechanical ventilation, further clinical evaluation is needed before their widespread diffusion into clinical practice.
Conti
Giorgio
G
Department of Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy. g.conti@rm.unicatt.it
Costa
Roberta
R
D004059:Diffusion of Innovation; D006801:Humans; D007558:Italy; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy; D013813:Therapy, Computer-Assisted