Closed-loop mechanical ventilation. Discussion

Closed-loop mechanical ventilation encompasses a plethora of techniques, ranging from the very simple to the relatively complex. In the simplest form, closed-loop ventilation is the control of one output variable of the mechanical ventilator based on the measurement of an input variable. An example would be pressure support ventilation, in which flow (output) is constantly changing to maintain pressure (input) constant throughout inspiration. More complex forms of closed-loop ventilation involve measurement of multiple inputs (eg, compliance, oxygen saturation, respiratory rate) to control multiple outputs (eg, ventilator frequency, airway pressure, tidal volume). The latter type of control more closely mimics the ventilatory control and response of human physiology. This review discusses both currently available closed-loop ventilation techniques and those only available outside the United States, along with some cutting-edge techniques that have only limited use. The operation, theoretical advantages, and limitations of each technique are reviewed. When available, the literature supporting or refuting each technique will be reviewed, but, unfortunately, little has been published on certain techniques.