Kevin P Seitz, Bradley D Lloyd, Li Wang, Matthew S Shotwell, Edward T Qian, Amelia L Muhs, Roger K Richardson, J Craig Rooks, Vanessa Hennings-Williams, Claire E Sandoval, Whitney D Richardson, Tracy L Morgan, Amber N Thompson, Pamela G Hastings, Terry P Ring, Joanna L Stollings, Erica M Talbot, David J Krasinski, Bailey R DeCoursey, Tanya K Marvi, Stephanie C DeMasi, Kevin W Gibbs, Wesley H Self, Amanda S Mixon, Todd W Rice, Matthew W Semler, Jonathan D Casey
{"title":"呼吸机模式对危重成人无呼吸机天数的影响：一项随机临床试验。","authors":"Kevin P Seitz, Bradley D Lloyd, Li Wang, Matthew S Shotwell, Edward T Qian, Amelia L Muhs, Roger K Richardson, J Craig Rooks, Vanessa Hennings-Williams, Claire E Sandoval, Whitney D Richardson, Tracy L Morgan, Amber N Thompson, Pamela G Hastings, Terry P Ring, Joanna L Stollings, Erica M Talbot, David J Krasinski, Bailey R DeCoursey, Tanya K Marvi, Stephanie C DeMasi, Kevin W Gibbs, Wesley H Self, Amanda S Mixon, Todd W Rice, Matthew W Semler, Jonathan D Casey","doi":"10.1016/j.chest.2025.03.024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown.</p><p><strong>Research question: </strong>What are the effects of 3 common ventilator modes (volume control vs pressure control vs adaptive pressure control) on death and duration of mechanical ventilation among critically ill adults?</p><p><strong>Study design and methods: </strong>We conducted a pragmatic, cluster-randomized, crossover pilot trial among adults receiving invasive mechanical ventilation in a medical ICU between November 1, 2022, and July 31, 2023. Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation. The primary outcome was ventilator-free days through 28 days.</p><p><strong>Results: </strong>Among 566 patients included in the primary analysis, the median proportion of ventilator mode assessments in the assigned mode during the first 72 hours was 100% in each group. The median number of ventilator-free days was 23 days (interquartile range [IQR], 0-26 days) in the volume control group, 22 days (IQR, 0-26 days) in the pressure control group, and 24 days (IQR, 0-26 days) in the adaptive pressure control group (P = .60). The median tidal volume was similar among the 3 groups, but the percentage of breaths > 8 mL/kg of predicted body weight differed among the volume control (median, 4.0% [IQR, 0.0%-14.1%]), pressure control (median, 10.6% [IQR, 0.0%-31.5%]), and adaptive pressure control (median, 4.7% [IQR, 0.0%-19.2%]) groups.</p><p><strong>Interpretation: </strong>This pilot trial established the feasibility of conducting a cluster-randomized crossover trial of ventilator mode among critically ill adults receiving invasive mechanical ventilation and demonstrated differences in intermediate outcomes that warrant further investigation in a larger trial.</p><p><strong>Clinical trial regristation: </strong>ClinicalTrials.gov; No.: NCT05563779; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5000,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of Ventilator Mode on Ventilator-Free Days in Critically Ill Adults: A Randomized Clinical Trial.\",\"authors\":\"Kevin P Seitz, Bradley D Lloyd, Li Wang, Matthew S Shotwell, Edward T Qian, Amelia L Muhs, Roger K Richardson, J Craig Rooks, Vanessa Hennings-Williams, Claire E Sandoval, Whitney D Richardson, Tracy L Morgan, Amber N Thompson, Pamela G Hastings, Terry P Ring, Joanna L Stollings, Erica M Talbot, David J Krasinski, Bailey R DeCoursey, Tanya K Marvi, Stephanie C DeMasi, Kevin W Gibbs, Wesley H Self, Amanda S Mixon, Todd W Rice, Matthew W Semler, Jonathan D Casey\",\"doi\":\"10.1016/j.chest.2025.03.024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown.</p><p><strong>Research question: </strong>What are the effects of 3 common ventilator modes (volume control vs pressure control vs adaptive pressure control) on death and duration of mechanical ventilation among critically ill adults?</p><p><strong>Study design and methods: </strong>We conducted a pragmatic, cluster-randomized, crossover pilot trial among adults receiving invasive mechanical ventilation in a medical ICU between November 1, 2022, and July 31, 2023. Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation. The primary outcome was ventilator-free days through 28 days.</p><p><strong>Results: </strong>Among 566 patients included in the primary analysis, the median proportion of ventilator mode assessments in the assigned mode during the first 72 hours was 100% in each group. The median number of ventilator-free days was 23 days (interquartile range [IQR], 0-26 days) in the volume control group, 22 days (IQR, 0-26 days) in the pressure control group, and 24 days (IQR, 0-26 days) in the adaptive pressure control group (P = .60). The median tidal volume was similar among the 3 groups, but the percentage of breaths > 8 mL/kg of predicted body weight differed among the volume control (median, 4.0% [IQR, 0.0%-14.1%]), pressure control (median, 10.6% [IQR, 0.0%-31.5%]), and adaptive pressure control (median, 4.7% [IQR, 0.0%-19.2%]) groups.</p><p><strong>Interpretation: </strong>This pilot trial established the feasibility of conducting a cluster-randomized crossover trial of ventilator mode among critically ill adults receiving invasive mechanical ventilation and demonstrated differences in intermediate outcomes that warrant further investigation in a larger trial.</p><p><strong>Clinical trial regristation: </strong>ClinicalTrials.gov; No.: NCT05563779; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>\",\"PeriodicalId\":9782,\"journal\":{\"name\":\"Chest\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":9.5000,\"publicationDate\":\"2025-04-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chest\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.chest.2025.03.024\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2025.03.024","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Effect of Ventilator Mode on Ventilator-Free Days in Critically Ill Adults: A Randomized Clinical Trial.
Background: Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown.
Research question: What are the effects of 3 common ventilator modes (volume control vs pressure control vs adaptive pressure control) on death and duration of mechanical ventilation among critically ill adults?
Study design and methods: We conducted a pragmatic, cluster-randomized, crossover pilot trial among adults receiving invasive mechanical ventilation in a medical ICU between November 1, 2022, and July 31, 2023. Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation. The primary outcome was ventilator-free days through 28 days.
Results: Among 566 patients included in the primary analysis, the median proportion of ventilator mode assessments in the assigned mode during the first 72 hours was 100% in each group. The median number of ventilator-free days was 23 days (interquartile range [IQR], 0-26 days) in the volume control group, 22 days (IQR, 0-26 days) in the pressure control group, and 24 days (IQR, 0-26 days) in the adaptive pressure control group (P = .60). The median tidal volume was similar among the 3 groups, but the percentage of breaths > 8 mL/kg of predicted body weight differed among the volume control (median, 4.0% [IQR, 0.0%-14.1%]), pressure control (median, 10.6% [IQR, 0.0%-31.5%]), and adaptive pressure control (median, 4.7% [IQR, 0.0%-19.2%]) groups.
Interpretation: This pilot trial established the feasibility of conducting a cluster-randomized crossover trial of ventilator mode among critically ill adults receiving invasive mechanical ventilation and demonstrated differences in intermediate outcomes that warrant further investigation in a larger trial.
期刊介绍：
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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