Early versus Delayed Switching from Controlled to Assisted Ventilation: A Target Trial Emulation

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Clinical Trials

Background:

• Switching to assisted ventilation is key for weaning patients from mechanical ventilation.
• Optimal timing for this switch remains unstudied in critically ill patients.

Purpose of the Study:

• To compare early versus delayed switching to assisted ventilation.
• To assess the impact on mechanical ventilation duration, ICU stay, and mortality.

Main Methods:

• Target trial emulation using the WEAN SAFE dataset.
• Compared early switching (within 1 day) vs. delayed switching (1+ days) after eligibility.
• Primary outcome: 28-day successful extubation; Secondary: ICU discharge, mortality.

Main Results:

• Early switching led to 4 additional days of successful extubation over 28 days.
• Associated with 7% higher cumulative incidence of successful extubation at Day 28.
• Increased ICU discharge by Day 28 (11%) and reduced ICU stay duration.

Conclusions:

• Early switching from controlled to assisted ventilation shortens mechanical ventilation duration.
• Early switching is linked to reduced intensive care unit length of stay.
• No significant difference in ICU mortality was observed between strategies.