Modern artificial lung ventilation is gradually moving away from the concept of rigidly set parameters that require constant manual adjustment and moving towards adaptive algorithms that can independently respond to changes in the patient's condition. If earlier the doctor or medical staff caring for the patient determined the ventilation parameters and periodically changed them based on clinical assessment, today the ventilator increasingly takes on part of this work, using feedback principles.
Intelligent ventilation modes are based on continuous analysis of such indicators as tidal volume, minute ventilation, respiratory rate, as well as mechanical properties of the lungs, in particular compliance. Based on this data, the system changes the level of support, trying to simultaneously ensure effective gas exchange and minimize the risks associated with excessive ventilation and minimize possible damage to the patient's lungs caused by artificial lung ventilation (VILI - Ventilator-Induced Lung Injury).
One of the key reasons for the implementation of intelligent modes is the need to adhere to a lung protection strategy. Excessive volumes or pressures can lead to additional damage to lung tissue, so modern algorithms are aimed at maintaining a stable tidal volume at the minimum required pressure. This is where adaptive modes demonstrate their advantage, as they are able to automatically adapt to changes in compliance, which can change rapidly in critically ill patients.
An equally important aspect is the process of weaning from mechanical ventilation. Classically, this process depended on the experience and skills of medical staff and involved a gradual reduction of support with periodic assessment of the patient's condition. Intelligent modes make this process more structured and predictable, since the device not only reduces support, but also constantly checks the patient's ability to breathe independently. Thus, a safer transition from fully controlled ventilation modes to spontaneous ones is formed.
PRVC as the basis of adaptive ventilation modes
Many modern intelligent algorithms are based on the PRVC (Pressure Regulated Volume Control) mode, which in itself is already adaptive. Its principle is that the device maintains a set tidal volume, automatically changing the pressure in the airways depending on the mechanics of the lungs. This allows you to avoid excessive pressure when improving compliance or, conversely, increase support when it decreases.
It is thanks to this property that PRVC is often used as a basic mode for building more complex algorithms that add to it the logic of automatic weaning, analysis of respiratory activity and transition between ventilation modes.
AutoControl from eVent Medical: adaptive transition from controlled to spontaneous ventilation
One example of a modern approach to weaning automation is the adaptive AutoControl mode, implemented in eVent Medical ventilators. Its key idea is not just to adapt ventilation parameters, but to guide the patient’s transition from fully controlled mode to spontaneous breathing with minimal support. This algorithm is combined with the strategy of protective ventilation of patients’ lungs on the Inspiration 7i and Evolution 3e models, and also includes tools for visualization of ventilation goals Target Tool and Lung Protective Zone tool, monitoring of ventilation pressure P (Driving Pressure), SI (stress index), monitoring of mechanical ventilation power in the new Evolution 3e ULTRA model.
The AutoControl algorithm begins with the stage of controlled ventilation in the PRVC-CMV mode, during which a stable minute or tidal volume is ensured. At this stage, the system accumulates data about the patient and forms a basic idea of his respiratory capabilities. After that, the respiratory activity assessment mechanism is launched, which can be initiated both by the doctor and automatically through the Adaptive Trigger Trial algorithm.
The key element is the Trigger Trial, a test during which the device gradually reduces the number of forced breaths, allowing the patient to demonstrate their own respiratory activity. This approach is fundamentally different from a sharp transition between modes, as it reduces the risk of instability and allows you to assess the patient’s real capabilities.
If the patient demonstrates the ability to maintain the required level of ventilation, the system transfers him to the PRVC-PS mode, where spontaneous breathing with support begins to play the main role. At the same time, the algorithm continues to monitor the patient’s condition and, if necessary, automatically returns him to controlled ventilation in cases of apnea or decreased minute volume.
Additionally, the system analyzes ventilation parameters and generates recommendations for conducting a spontaneous breathing test (SBT), which is the final stage before weaning from the device. Thus, AutoControl not only automates the ventilation process, but also acts as a tool to support clinical decisions.
Hamilton Medical’s approach: full automation of artificial lung ventilation
Hamilton Medical implements a different approach to adaptive ventilation in its ventilators, focusing on maximum automation of all parameters. ASV (Adaptive Support Ventilation) mode is based on mathematical models that determine the optimal ratio between respiratory rate and tidal volume, based on the concept of minimizing the work of breathing.
An extended version of the algorithm, INTELLiVENT-ASV, complements this approach by adding oxygenation control. In this mode, the device uses saturation (SpO₂) and capnography (EtCO₂) data to automatically adjust not only ventilation, but also oxygen level and PEEP (PTKV). The result is a closed-loop control system that requires virtually no physician intervention in standard clinical situations.
Dräger: algorithmic functionality to facilitate weaning from mechanical ventilation
In Dräger systems, the emphasis is on automating the weaning process. The SmartCare/PS mode implements a step-by-step reduction in pressure support, focusing on the stability of the patient's breathing. The system constantly evaluates the respiratory rate, tidal volume and other parameters, gradually reducing the level of support to the minimum.
Additionally, the Automode function is used, which provides automatic switching between controlled and spontaneous ventilation depending on the presence of respiratory activity. This avoids both excessive support and premature disconnection of the patient from the device.
Getinge (Maquet): synchronization with the patient's respiratory capabilities and neural control
In SERVO systems from Getinge, there are two key approaches. The first is Automode, which implements the logic of automatic transition between modes depending on respiratory activity. The second is NAVA (Neurally Adjusted Ventilatory Assist), which represents a fundamentally different level of adaptation, as it is based on signals from the diaphragm. The use of electrical activity of the diaphragm allows the device to synchronize with the patient much more precisely than with traditional triggers. This is especially important in patients with pronounced asynchrony or complex breathing mechanics.
Mindray and Löwenstein: a balance of adaptability and clinical simplicity
Mindray solutions combine adaptive algorithms with relative ease of use. Modes that support a given minute volume allow you to automatically change the frequency and tidal volume, ensuring stable ventilation without complex settings. Combined with built-in weaning protocols, this creates a universal solution for a wide range of clinical situations.
Löwenstein Medical, in turn, emphasizes adapting support to the patient's spontaneous breathing. Their systems are aimed at stabilizing the breathing pattern and increasing comfort, which is especially important during the weaning phase.
Thus, intelligent ventilation modes in 2026 form a new paradigm of intensive care, in which the ventilator becomes an active participant in the treatment process. Regardless of the implementation, all modern systems have a common goal: to provide lung protection, optimize gas exchange and make the weaning process as safe and predictable as possible.
The difference between manufacturers lies in the philosophy of implementing these tasks. Some systems emphasize full automation, others - on a controlled transition between modes or synchronization with the patient. In this context, the AutoControl solution from eVent Medical demonstrates a balanced approach, combining adaptability, control and clinical feasibility in the process of weaning a patient from mechanical ventilation.
