Rationale For critically ill adults receiving invasive mechanical ventilation, the ventilator mode determines how breaths are delivered. Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown. To compare the effects of three common ventilator modes (volume control, pressure control, and adaptive pressure control) on death and duration of mechanical ventilation.
Methods We conducted a pragmatic, cluster-randomized, crossover 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 number of ventilator-free days was 23 [IQR, 0-26] in the volume control group, 22 [0-26] in the pressure control group, and 24 [0-26] in the adaptive pressure control group (P=0.60). The median tidal volume was similar in the three groups, but the percentage of breaths larger than 8mL/kg of predicted body weight differed between volume control (median, 4.0%; IQR, 0.0-14.1), pressure control (10.6%; 0.0-31.5), and adaptive pressure control (4.7%; 0.0-19.2). Incidences of hypoxemia, acidemia, and barotrauma were similar in the three groups.
Conclusions Among critically ill adults receiving invasive mechanical ventilation, the use of volume control, pressure control, or adaptive pressure control did not affect the number of ventilator-free days, however, confidence intervals included differences that may be clinically meaningful.
Competing Interest StatementThe authors have declared no competing interest.
Clinical TrialNCT05563779
Funding StatementThis study did not receive any funding. KPS was supported by the NIH (T32HL087738); SCD was supported by the NIH (T32GM108554). WHS was supported in part by the NIH/NCATS (UL1 TR00243). TWR was supported by the NIH/NCATS (UL1 TR002243). MWS was supported by the NIH/NCATS (UL1 TR002243). JDC was supported by the NIH (K23HL153584).
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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The institutional review board of Vanderbilt University Medical Center gave ethical approval for this work to be conducted with a waiver of informed consent.
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Data AvailabilityDeidentified participant data and a data dictionary will be available to researchers whose research proposal is approved by the principal investigator in addition to approval by an Institutional Review Board and an executed data use agreement. Data will become available 3 months following publication of outcomes and will remain available for at least 5 years.
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