Critical Care: Original Research

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

Kevin P. Seitz, Bradley D. Lloyd, Li Wang, et al

Chest Available online 4 April 2025

https://doi.org/10.1016/j.chest.2025.03.024

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.

Clinical Trial Regristation

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