Effect of Ventilator Mode on Ventilator-Free Days in Critically Ill Adults: A Randomized Clinical Trial.

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?

在危重病成人中，三种常见的呼吸机模式（容量控制、压力控制、自适应压力控制）对死亡率和机械通气持续时间有何影响？

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.

我们在2022年11月1日至2023年7月31日期间，对在内科重症监护病房接受有创机械通气的成人进行了一项实用的、群组随机、交叉试点试验。

Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation.

在参与的单位中，患者每个月被分配在持续强制通气期间接受容量控制、压力控制或自适应压力控制。

The primary outcome was ventilator-free days through 28 days.

主要结果是28天内无呼吸机天数。

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.

在纳入主要分析的566名患者中，首次72小时内分配模式下呼吸机模式评估的中位比例在每组均为100%。

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).

在容量控制组中，呼吸机自由日的中位数为23天（四分位数范围[IQR]，0-26天），压力控制组为22天（IQR，0-26天），自适应压力控制组为24天（IQR，0-26天）（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.

三组之间的中位潮气量相似，但容量控制组（中位数，4.0% [IQR，0.0%-14.1%]）、压力控制组（中位数，10.6% [IQR，0.0%-31.5%]）和自适应压力控制组（中位数，4.7% [IQR，0.0%-19.2%]）之间，呼吸次数占预测体重8 mL/kg以上的百分比存在差异。

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.

该试点试验证明了在重症成人接受有创机械通气患者中开展通气模式的群组随机交叉试验的可行性，并揭示了一些中间结果的差异，这些差异值得在更大规模的试验中进一步研究。

clinical_trial_regristation

ClinicalTrials.gov; No.: NCT05563779; URL: www.

ClinicalTrials.gov; 编号：NCT05563779; 网址：www.

clinicaltrials

gov.

5年总生存率为65%（95%置信区间，58%-72%）。