New and future developments to improve patient-ventilator interaction.

The new and future developments to improve the patient-ventilator interaction are mainly based on the concept of the tight coupling between neural output and ventilator function. This tight coupling should be present throughout a patient's respiratory cycle, a task that is demanding from a technical point of view. By achieving a tight neuromechanical coupling, the ventilator operates as an external respiratory muscle of high capabilities controlled mainly by the patient. This task, however, necessitates knowledge of respiratory system physiology and pathophysiology and the interaction between patient and ventilator. Although currently sophisticated computer algorithms have been developed, the caregiver is the one who controls the patient-ventilator system. Without indepth knowledge of this system, the algorithms may induce harm rather than benefit.