Purpose of review: Mechanical ventilation is one of the most important life support tools in the ICU, but it may also be harmful by causing ventilator-induced lung injury (VILI) and other deleterious effects. Advances in ventilator technology have allowed the introduction of numerous ventilator modes in an effort to improve gas exchange, reduce the risk of VILI, and finally improve outcome. In this review, we will summarize the studies evaluating some of the nonconventional ventilation techniques and discuss their possible use in clinical practice.
Recent findings: Proportional assist ventilation and neurally adjusted ventilator assist are able to improve patient-ventilator synchrony, possibly sleep, and may be better tolerated than pressure support ventilation; both integrate the physiological concept of respiratory variability like noisy ventilation. Experimental or short-term clinical studies have shown physiological benefits with the application of biphasic pressure modes. Some of the automated weaning algorithms may reduce time spent on ventilator and decrease ICU stay, especially in a busy environment.
Summary: Apart from the physiological and clinical attractiveness demonstrated in animals and small human studies, most of the nonconventional ventilator modes must prove their clinical benefits in large prospective trials before being applied in daily clinical practice.