Advanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare)

Best Pract Res Clin Anaesthesiol. 2009 Mar;23(1):81-93. doi: 10.1016/j.bpa.2008.08.001.


New 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.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Humans
  • Respiration, Artificial* / methods
  • Respiration, Artificial* / trends
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy
  • Respiratory Mechanics
  • Therapy, Computer-Assisted*
  • Ventilator Weaning / methods