• Giorgio Conti and Roberta Costa.
• Department of Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy. g.conti@rm.unicatt.it
• Curr Opin Crit Care. 2010 Feb 1;16(1):26-33.

Purpose Of ReviewInnovative modes of mechanical ventilation, mainly based on complex closed loop technologies, have been recently developed and are now available for clinical use.Recent FindingsProportional 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.SummaryThe 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.

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