When the Breath Leads: Lessons from Ventilation Modes

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# When the Breath Leads: Lessons from Ventilation Modes

Volume Assist/Control (V-A/C) remains one of the most widely used ventilation modes in intensive care — predictable, stable, and trusted by clinicians worldwide. But clinical data reveals a deeper truth: prolonged control can weaken the diaphragm and delay weaning.

The real challenge isn't choosing between control and spontaneity. It's finding the balance between the two.

The Paradox of Control

V-A/C works by delivering a set tidal volume with each breath, ensuring consistent ventilation regardless of patient effort. This predictability is its strength — and its limitation.

What makes V-A/C successful:

Guaranteed minute ventilation in unstable patients

Precise control during the acute phase of respiratory failure

Simplified monitoring with predictable breath delivery **Where it struggles:**

Patient-ventilator asynchrony when effort returns

Diaphragm atrophy from prolonged passive ventilation

Delayed transition to weaning modes

From Dictation to Collaboration

The future of mechanical ventilation lies in adaptive systems that learn to listen rather than dictate. Instead of fixed parameters, imagine ventilators that:

Detect patient effort and adjust support in real-time

Predict readiness for weaning based on respiratory mechanics

Minimize diaphragm disuse while maintaining adequate support This shift from control to collaboration represents a fundamental change in how we think about respiratory support.

Building Smarter Respiratory Care

As a product manager in MedTech, these clinical insights directly inform product strategy. The goal isn't to replace clinician judgment — it's to augment it with intelligent systems that recognize patterns, anticipate needs, and support better outcomes.

The breath should lead. Technology should follow. And together, they should guide patients from crisis to recovery.

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Nandhini skipped presentations and built real AI products.

Nandhini Sivakumar was part of the September 2025 cohort at Curious PM, alongside 13 other talented participants.