Mechanical ventilators have become more sophisticated with the advent of mi
croprocessor control. Advances in monitoring have also improved our ability
to harmonize patient-ventilator interaction. The next obvious step in this
technologic progression is to turn over some decision making to the ventil
ator, In the jargon of today, we are "closing the loop." Ventilators have u
sed closed-loop control for simple tasks for the last decade. Newer closed-
loop processes include modes that increase or decrease support based on a s
ingle-monitored variable. An example is the automated control of pressure s
upport to maintain a deired tidal volume. More sophisticated closed-loop te
chniques, such as proportional assist ventilation and adaptive support vent
ilation, not only monitor multiple input variables but also use closed-loop
control of several variables, This article reviews the closed-loop ventila
tion modes currently available to clinicians.