• François Lellouche and Laurent Brochard.
• 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
• Best Pract Res Clin Anaesthesiol. 2009 Mar 1; 23 (1): 81-93.

AbstractNew 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.

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