Proportional assist ventilation combined with automatic tube compensation. A promising concept of augmented spontaneous breathing?

Abstract

The combination of proportional assist ventilation (PAV) and automatic tube compensation (ATC) is a promising concept for partial ventilatory support. In contrast to conventional pressure support ventilation (PSV), PAV+ATC provides dynamic pressure support depending on the patient's initial inspiratory effort. PAV+ATC should selectively unload the respiratory muscles from the additional workload imposed by increased respiratory system resistance and elastance as well as by endotracheal tube resistance. Patients have the ability to modify the tidal volume in response to changes in ventilatory demand, thereby improving patient-ventilator interaction and breathing comfort when compared with PSV. However, since routine measurements of respiratory mechanics during augmented spontaneous breathing are currently unavailable but would be necessary for setting the support level as a function of respiratory system mechanics during PAV, this mode cannot yet be generally recommended for routine clinical use.