Department of Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy.
Curr Opin Crit Care. 2010 Feb;16(1):26-33. doi: 10.1097/MCC.0b013e328334b1e3.
Innovative modes of mechanical ventilation, mainly based on complex closed loop technologies, have been recently developed and are now available for clinical use.
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.
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.
创新性的机械通气模式，主要基于复杂的闭环技术，最近已经开发出来并可用于临床。
带可调节增益因子的比例辅助通气和神经调节通气辅助是创新性的机械通气模式，可提供与患者努力成比例的辅助水平，从而改善患者-通气机同步性，并可能具有真正的临床优势。适应性支持通气是一种通气模式，提供辅助（压力支持通气样）或控制呼吸周期（压力控制样），与临床医生设定的分钟通气目标以及对患者呼吸力学的自动测量相关。最后，噪声辅助压力支持通气是压力支持的最近描述的实验演变，具有一些改进潜力，但目前尚无临床应用。
带可调节增益因子的比例辅助通气、神经调节通气辅助和适应性支持通气的最近报道结果主要基于初步的生理学和临床研究；尽管它们似乎很有前途，表明基于闭环的模式可能代表机械通气领域的真正创新，但在广泛应用于临床实践之前，还需要进一步的临床评估。
