Adaptive lung ventilation

Adaptive lung ventilation (ALV) is a method of closed-loop mechanical ventilation analogous to modern closed-loop technology in aviation such as the autopilot and automatic landing system. The algorithm of the controller of ALV is designed to automatically provide pressure-controlled synchronized intermittent mandatory ventilation (P-SIMV) and weaning as individually required in any clinical situation. The synchronized pressure limited breaths constantly adapt to the patient requirements to encourage optimal alveolar ventilation with minimal adverse physiological disturbance and timely weaning. The ease of application, efficiency, and safety of the first ALV controllers have been demonstrated in lung models, in patients with normal lungs undergoing general anesthesia, in patients requiring unusual positioning, in transition to and from one-lung anesthesia, and in long-term ventilation of patients with various lung pathologies and in weaning patients who have restrictive or obstructive pulmonary disease. Prospective comparative studies of ALV versus other currently used manually selected modes of mechanical ventilation, such as the one reported in this article, should confirm the safety and identify the benefits of this form of advanced closed-loop mechanical ventilation technology.