PT  - JOURNAL ARTICLE
AU  - Gibbs, Kevin W
AU  - Forbes, Jonathan L
AU  - Harrison, Kelsey J
AU  - Krall, Jennifer TW
AU  - Isenhart, Aubrae A
AU  - Taylor, Stephanie P
AU  - Martin, R Shayn
AU  - O'Connell, Nathaniel S
AU  - Bakhru, Rita N
AU  - Palakshappa, Jessica A
AU  - Files, D Clark
TI  - A Pragmatic Pilot Trial Comparing Patient-Triggered Adaptive Pressure Control to Patient-Triggered Volume Control Ventilation in Critically Ill Adults
AID  - 10.4187/respcare.10803
DP  - 2023 Oct 01
TA  - Respiratory Care
PG  - 1331--1339
VI  - 68
IP  - 10
4099  - http://rc.rcjournal.com/content/68/10/1331.short
4100  - http://rc.rcjournal.com/content/68/10/1331.full
AB  - BACKGROUND: Patient-triggered adaptive pressure control (APC) continuous mandatory ventilation (CMV) (APC-CMV) has been widely adopted as an alternative ventilator mode to patient-triggered volume control (VC) CMV (VC-CMV). However, the comparative effectiveness of the 2 ventilator modes remains uncertain. We sought to explore clinical and implementation factors pertinent to a future definitive randomized controlled trial assessing APC-CMV versus VC-CMV as an initial ventilator mode strategy. The research objectives in our pilot trial tested clinician adherence and explored clinical outcomes.METHODS: In a single-center pragmatic sequential cluster crossover pilot trial, we enrolled all eligible adults with acute respiratory failure requiring mechanical ventilation admitted during a 9-week period to the medical ICU. Two-week time epochs were assigned a priori in which subjects received either APC-CMV or VC-CMV The primary outcome of the trial was feasibility, defined as 80% of subjects receiving the assigned mode within 1 h of initiation of ICU ventilation. The secondary outcome was proportion of the first 24 h on the assigned mode. Finally, we surveyed clinician stakeholders to understand potential facilitators and barriers to conducting a definitive randomized trial.RESULTS: We enrolled 137 subjects who received 152 discreet episodes of mechanical ventilation during time epochs assigned to APC-CMV (n = 61) and VC-CMV (n = 91). One hundred and thirty-one episodes were included in the prespecified primary outcome. One hundred and twenty-six (96%) received the assigned mode within the first hour of ICU admission (60 of 61 subjects assigned APC-CMV and 66 of 70 assigned VC-CMV). VC-CMV subjects spent a lower proportion of first 24 h (84% [95% CI 78–89]) on the assigned mode than APC-CMV recipients (95% [95% CI 91–100]). Mixed-methods analyses identified preconceived perceptions of subject comfort by clinicians and need for real-time education to address this concern.CONCLUSIONS: In this pilot pragmatic, sequential crossover trial, unit-wide allocation to a ventilator mode was feasible and acceptable to clinicians.