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Review
. 2023 Feb 1;29(1):19-25.
doi: 10.1097/MCC.0000000000001012. Epub 2022 Dec 9.

Closed-loop ventilation

Jean-Michel Arnal  1   2 , Shinshu Katayama  3 , Christopher Howard  4
Affiliations
Review

Closed-loop ventilation

Jean-Michel Arnal et al. Curr Opin Crit Care. .

Abstract

Purpose of review: The last 25 years have seen considerable development in modes of closed-loop ventilation and there are now several of them commercially available. They not only offer potential benefits for the individual patient, but may also improve the organization within the intensive care unit (ICU). Clinicians are showing both greater interest and willingness to address the issues of a caregiver shortage and overload of bedside work in the ICU. This article reviews the clinical benefits of using closed-loop ventilation modes, with a focus on control of oxygenation, lung protection, and weaning.

Recent findings: Closed-loop ventilation modes are able to maintain important physiological variables, such as oxygen saturation measured by pulse oximetry, tidal volume (VT), driving pressure (ΔP), and mechanical power (MP), within target ranges aimed at ensuring continuous lung protection. In addition, these modes adapt the ventilator support to the patient's needs, promoting diaphragm activity and preventing over-assistance. Some studies have shown the potential of these modes to reduce the duration of both weaning and mechanical ventilation.

Summary: Recent studies have primarily demonstrated the safety, efficacy, and feasibility of using closed-loop ventilation modes in the ICU and postsurgery patients. Large, multicenter randomized controlled trials are needed to assess their impact on important short- and long-term clinical outcomes, the organization of the ICU, and cost-effectiveness.

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References

    1. Platen PV, Pomprapa A, Lachmann B, et al. The dawn of physiological closed-loop ventilation-a review. Crit Care 2020; 24:121.
    1. Egi M, Kataoka J, Ito T, et al. Oxygen management in mechanically ventilated patients: a multicenter prospective observational study. J Crit Care 2018; 46:1–5.
    1. Ke ZW, Jiang Y, Bao YP, et al. Intensivists’ response to hyperoxemia in mechanical ventilation patients: the status quo and related factors. World J Emerg Med 2021; 12:202–206.
    1. Madotto F, Rezoagli E, Pham T, et al. Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study. Crit Care 2020; 24:125.
    1. Aggarwal NR, Brower RG, Hager DN, et al. Oxygen exposure resulting in arterial oxygen tensions above the protocol goal was associated with worse clinical outcomes in acute respiratory distress syndrome. Crit Care Med 2018; 46:517–524.