Silva et al. Personalized Mechanical Ventilation Settings: Slower Is Better! In: Annual Update in Intensive Care and Emergency Medicine 2022

In this book chapter on individualized mechanical ventilation approaches Prof. Pelosi and colleagues acknowledge FCV as a potential strategy to improve respiratory function and reduce VILI. The authors elaborate on the fact that rapid changes of ventilatory variables in time, meaning a high strain rate, lower the threshold for stress injury and ventilator-induced lung damage, especially in heterogeneous lungs. This may be prevented during FCV, with its constant and relatively low flow applied throughout the ventilation cycle, without zero-flow phases. By actively controlling the expiratory phase, the appearance of intrinsic PEEP may be avoided, which in turn promotes better air exhalation among alveoli with different time constants. Furthermore, the authors note that the direct intratracheal pressure measurements allow a much more precise analysis of individual lung mechanics than conventional strategies. Consequently, gradual increases of tidal volumes that may be applied during individualization of FCV are directly related to individual dynamic compliance and reflect ventilation of the available aerated lung tissue, and simultaneously decrease the risk of atelectasis and/or overdistension.