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Effort-adapted modes of assisted breathing.
MedLine Citation:
PMID:  22222841     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: New developments in mechanical ventilation have focused on increasing the patient's control of the ventilator by implementing information on lung mechanics and respiratory drive. Effort-adapted modes of assisted breathing are presented and their potential advantages are discussed.
RECENT FINDINGS: Adaptive support ventilation, proportional assist ventilation with load adjustable gain factors and neurally adjusted ventilatory assist are ventilatory modes that follow the concept of adapting the assist to a defined target, instantaneous changes in respiratory drive or lung mechanics. Improved patient ventilator interaction, sufficient unloading of the respiratory muscles and increased comfort have been recently associated with these ventilator modalities. There are, however, scarce data with regard to outcome improvement, such as length of mechanical ventilation, ICU stay or mortality (commonly accepted targets to demonstrate clinical superiority).
SUMMARY: Within recent years, a major step forward in the evolution of assisted (effort-adapted) modes of mechanical ventilation was accomplished. There is growing evidence that supports the physiological concept of closed-loop effort-adapted assisted modes of mechanical ventilation. However, at present, the translation into a clear outcome benefit remains to be proven. In order to fill the knowledge gap that impedes the broader application, larger randomized controlled trials are urgently needed. However, with clearly proven drawbacks of conventional assisted modes such as pressure support ventilation, it is probably about time to leave these modes introduced decades ago behind.
Authors:
Onnen Moerer
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current opinion in critical care     Volume:  18     ISSN:  1531-7072     ISO Abbreviation:  Curr Opin Crit Care     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-06     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  61-9     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Georg-August-University Göttingen, Göttingen, Germany.
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