Patients' demands are changing with time because of the evolution of treatment methods. Therefore, an optimal ventilation strategy must treat the acute condition and support the gradual weaning from the ventilator.
FREMONT, CA: The combination of physiology, medicine, and engineering principles contributes to the development and advancement of mechanical ventilation, emphasizing the most urgent requirements for improvement and the most promising directions of further development. Several aspects of mechanical ventilation are introduced, focusing on one side the essentiality of interdisciplinary research for future development and, on the other, the necessity of training physicians sufficiently on the technological aspects of modern devices to exploit the great complexity and abilities of this treatment properly.
Compared to earlier generations of mechanical ventilators, microprocessors' use enables the development of sophisticated signal processing algorithms to compensate for intrinsic flaws in sensors, consequently enhancing performance. These algorithms are unknown to the users, who cannot predict the behavior of the ventilator in situations and conditions different from these considered during the development of the algorithms. As measurements are obtained by integrating the flow signals, the signal processing also contributes to volume accuracy by compensating for drift and leaks, especially during noninvasive ventilation, where leak estimation and compensation algorithms play a significant role.
The idea of automating mechanical ventilation was found in the early years. The technology of intelligent ventilators enhances patient management by analyzing and integrating information coming from several sources and guaranteeing continuous adjustment of the ventilation even when expert personnel are not available, bettering patients' treatment and minimizing clinical errors. Moreover, these tools can also be leveraged for educational purposes.
Ventilation management is a complex process comprising multiple parameters, subjective strategies, and multiple objectives. Physiology, and the peculiarity of the pathology, must be taken into account. Several clinical data must be collected from many sources, and the condition of the patient must be monitored continually. Finally, priorities of aims, clinical preferences, and local clinical protocols must also be considered. When deploying these strategies in mechanical ventilators, there is the requirement to identify a trade-off between the complete description of the patient condition and the complexity of managing variables, availability of the data, invasiveness of measurements, and data acquisition from various equipments.