investigational modes and high frequency mechanical ventilation is not recommended in

adults. (See "Modes of mechanical ventilation".)

Regardless of the initial mode selected, it is not infrequent that the mode of ventilation be
changed when a patient demonstrates intolerance of selected mode or demonstrates the
signs of dyssynchrony. (See "Ventilator management strategies for adults with acute
respiratory distress syndrome", section on 'Treat dyssynchrony'.)

The modes of mechanical ventilation are distinguished from each other by the types of
breaths that they deliver ( table 4). In brief, the delivery of breaths is typically either
volume-limited or pressure-limited:

● Volume-limited – Volume-limited breaths can be ventilator-initiated (also known as

volume-controlled or volume-cycled [VC]) or patient initiated (also known as volume-
assist [VA]). VC or VA breaths deliver a predetermined tidal volume at a set ventilator
rate such that a minimum minute ventilation (tidal volume x respiratory rate) is
guaranteed. Each tidal volume is delivered at a set inspiratory flow rate and inspiration
is terminated once the set tidal volume has been delivered. Airway pressure is
determined by the airway resistance, lung compliance, and chest wall compliance.
Modes of mechanical ventilation used in the ICU that can deliver VC or VA breaths
include volume-limited assist control and volume-limited SIMV. Volume-limited
continuous mechanical ventilation (VC-CMV) is not generally needed in the ICU.
Pressure-regulated volume controlled ventilation (PRVC) is being increasingly used. In
PRVC, a set tidal volume is targeted by varying airway pressure resulting in variable
inspiratory flow. Further details are provided separately. (See "Modes of mechanical
ventilation", section on 'Volume-limited ventilation'.)

● Pressure limited – Pressure-limited breaths can be ventilator-initiated (also known as

pressure-control or pressure-cycled [PC]) or patient initiated (also known as pressure-
assist [PA]). In PC or PA breaths, the flow of air into the lung is determined by a set
pressure limit and the rate is determined by a set ventilator rate. Inspiration is
terminated once the set inspiratory time has elapsed. The tidal volume is variable and
related to compliance, airway resistance, and tubing resistance. A consequence of the
variable tidal volume is that a specific minute ventilation cannot be guaranteed. Modes
of mechanical ventilation used in the ICU that deliver PC or PA breaths include
pressure-limited assist control and pressure-limited SIMV. Pressure-limited continuous
mechanical ventilation (PC-CMV) is not generally needed in the ICU. Further details are
provided separately. (See "Modes of mechanical ventilation", section on 'Pressure-
limited ventilation'.)

● Pressure support – Spontaneous breathing can be supported to a set pressure limit;

such breaths are called "pressure support (PS) breaths." The ventilator provides the