Closed-loop synchronization versus conventional synchronization in spontaneously breathing pediatric patients...

Area of Science:

• Pediatric critical care medicine
• Respiratory physiology
• Biomedical engineering

Background:

• Patient-ventilator asynchrony (PVA) is a frequent complication in pediatric invasive mechanical ventilation.
• PVA can increase respiratory workload, discomfort, and potentially prolong ventilation duration.
• The IntelliSync+ (IS+) algorithm offers real-time closed-loop synchronization to optimize ventilator settings.

Purpose of the Study:

• To evaluate the efficacy and safety of the IntelliSync+ (IS+) algorithm.
• To compare IS+ with conventional physician-tailored synchronization in pediatric patients.
• To assess the impact of IS+ on patient-ventilator interaction and clinical outcomes.

Main Methods:

• A multicenter, prospective, randomized controlled, single-blind crossover trial was conducted.
• Pediatric patients (1 month to 18 years) on invasive mechanical ventilation were randomized to IS+ or conventional synchronization.
• The primary outcome was the Asynchrony Index (AI), with secondary outcomes including comfort scores and physiological parameters.

Main Results:

• IS+ significantly reduced the overall Asynchrony Index (AI) compared to conventional synchronization (5.1% vs. 12.4%, P < 0.001).
• Significant reductions were observed in major and minor asynchrony indices, double triggering, auto-triggering, and trigger delay.
• Comfort-B scores improved modestly, while oxygen saturation and leak remained stable; EtCO2 decreased.

Conclusions:

• Closed-loop synchronization with IS+ effectively improves patient-ventilator interaction in pediatric invasive mechanical ventilation.
• IS+ demonstrated safety and efficacy without negatively impacting oxygenation or patient comfort.
• The findings support IS+ as a feasible and beneficial strategy for enhancing ventilatory support quality in critically ill children.