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11.08.2020 | Narrative Review

Proportional modes of ventilation: technology to assist physiology

verfasst von: Annemijn H. Jonkman, Michela Rauseo, Guillaume Carteaux, Irene Telias, Michael C. Sklar, Leo Heunks, Laurent J. Brochard

Erschienen in: Intensive Care Medicine | Ausgabe 12/2020

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Abstract

Proportional modes of ventilation assist the patient by adapting to his/her effort, which contrasts with all other modes. The two proportional modes are referred to as neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation with load-adjustable gain factors (PAV+): they deliver inspiratory assist in proportion to the patient’s effort, and hence directly respond to changes in ventilatory needs. Due to their working principles, NAVA and PAV+ have the ability to provide self-adjusted lung and diaphragm-protective ventilation. As these proportional modes differ from ‘classical’ modes such as pressure support ventilation (PSV), setting the inspiratory assist level is often puzzling for clinicians at the bedside as it is not based on usual parameters such as tidal volumes and PaCO₂ targets. This paper provides an in-depth overview of the working principles of NAVA and PAV+ and the physiological differences with PSV. Understanding these differences is fundamental for applying any assisted mode at the bedside. We review different methods for setting inspiratory assist during NAVA and PAV+ , and (future) indices for monitoring of patient effort. Last, differences with automated modes are mentioned.

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Titel: Proportional modes of ventilation: technology to assist physiology
verfasst von: Annemijn H. Jonkman
Michela Rauseo
Guillaume Carteaux
Irene Telias
Michael C. Sklar
Leo Heunks
Laurent J. Brochard
Publikationsdatum: 11.08.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06206-z

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Proportional modes of ventilation: technology to assist physiology

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