Geo–economic variations in care for invasively ventilated patients: The potential benefits of closed–loop ventilation in resource–limited settings

Lung–protective ventilation for invasively ventilated patients mimics normal breathing in which a low tidal volume is delivered at a specific respiratory rate with a limited inspiratory pressure on top of a sufficient level of positive end–expiratory pressure. It has been thoroughly demonstrated that despite being an expensive procedure, invasive ventilation when applied in a lung-protective way has a strong potential to improve the outcome of critically ill patients. However, implementing lung–protective ventilation has several challenges, including the fact that it can be quite time–consuming. One way to facilitate the use of lung–protective ventilation is to automate the settings involved with this strategy with closed–loop ventilation. In this review, we compare the epidemiology, ventilator management, and outcomes in critically ill ICU patients between middle–income countries and high–income countries and focus on the potentials and risks of closed–loop ventilation in middle–income countries.