Respiratory failure & ventilation
Pressure control plus spontaneous ventilation versus volume assist-control ventilation in acute respiratory distress syndrome. A randomised clinical trial
Primary result · Hospital mortalityResult — go to the resultRelative risk 1.03 95% CI 0.84–1.27- Similar tidal volume (6 mL/kg predicted body weight) and positive end-expiratory pressure (PEEP) targets; paralysis stopped after 24 h, sedation adapted to favour spontaneous ventilation
Authors' conclusion
A strategy based on PC-SV mode that favours spontaneous ventilation reduced the need for sedation and adjunctive therapies of hypoxemia but did not significantly reduce mortality compared to ACV with similar tidal volume and PEEP levels.
Study context
- Population
- Adults with moderate or severe acute respiratory distress syndrome (ARDS) (PaO2/FiO2 < 200 mmHg), 22 intensive care units (ICUs) in France, 2013–2018
- Participants
- 700 adults · 22 ICUs
- Comparison
- PC-SV vs ACV
- PC-SVn = 348
- ACVn = 352reference
- Primary endpoint
- In-hospital death from any cause
- Follow-up
- Day 60
Methodological detailsopen-label, multicentre
- Open-label
- Multicentre
Primary result
Hospital mortality
Relative risk
1.03
95% CI 0.84–1.27
P = 0.77
By group
PC-SV vs ACV
RR 1.03 (95% CI 0.84–1.27); P = 0.77
As reported in the abstract
Further findings
| Outcome | PC-SV | ACV | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Adjunctive therapy of hypoxemia (including prone positioning) | 33.1% | 41.3% | 0.80 (0.66–0.98) | P = 0.03 | |
| 0.512Relative risk (log scale) |
28-day mortality, ventilator-free days and organ failure-free days at day 28
- Did not differ between PC-SV and ACV
Sedation and NMBA use
- Significantly less in PC-SV than ACV
Safety
Pneumothorax and refractory hypoxemia
- Incidences did not differ between the groups
Original publication
Pressure control plus spontaneous ventilation versus volume assist-control ventilation in acute respiratory distress syndrome. A randomised clinical trial. Intensive Care Med. Published 17 September 2024. doi:10.
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