PERSONALIZED MECHANICAL VENTILATION: INTEGRATING LUNG MECHANICS, RESPIRATORY MONITORING AND ADAPTIVE CONTROL TECHNOLOGIES

Abstract

Mechanical ventilation sustains life in patients with acute respiratory failure, yet the support itself may injure both the lung and the diaphragm. Protective strategies based on predicted-body-weight tidal volumes and fixed positive end-expiratory pressure tables do not account for the heterogeneity of lung mechanics or for between-patient variability in inspiratory effort. This interdisciplinary narrative review aimed to articulate the physiological rationale for ventilatory individualisation with the technical chain that enables it — instrumentation, system identification and feedback control — while making explicit the contributions of mechanical engineering at each stage. Five synthesis studies published between 2023 and 2026 were analysed, complemented by seminal references on respiratory mechanics and by technical standards applicable to critical care ventilators. Findings were organised into four functional layers analogous to those of a mechatronic system: instrumentation, processing and estimation, decision and control, and actuation and safety. The physiological basis and the technological maturity of personalisation are well established, whereas clinical evidence of superiority over conventional protocols remains absent for hard outcomes, and verification and validation standards for the computational models in use are still lacking. Progress in the field appears to depend less on new control technologies than on the identification of patient phenotypes and on the consolidation of model credibility criteria.