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Published on: December 5, 2025
Closed-loop versus conventional synchronization in spontaneously breathing adult patients- a randomized controlled
Ramazan Guven1, Cenk Kirakli2, Jean-Pierre Revely3
1Department of Emergency Medicine, University of Health Sciences Cam and Sakura Training and Research Hospital, Istanbul, Turkey; Department of Emergency Medicine, Atlas University Hospital, Faculty of Medicine, Istanbul, Turkey.
Journal of Critical Care
|August 14, 2026
Summary
The IntelliSync+ algorithm significantly reduces patient-ventilator asynchrony during noninvasive ventilation for acute respiratory failure. This closed-loop system improves patient comfort and synchrony without invasive monitoring.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Biomedical Engineering
Background:
- Noninvasive ventilation (NIV) is crucial for acute respiratory failure (ARF).
- Patient-ventilator asynchrony (PVA) during NIV can impair treatment efficacy and patient comfort.
- Optimizing synchrony is essential for effective NIV support.
Purpose of the Study:
- To evaluate the efficacy of the IntelliSync+ (IS+) closed-loop synchronization algorithm.
- To compare IS+ with conventional physician-tailored synchronization during NIV in adult ARF patients.
- To assess the impact of IS+ on patient-ventilator interaction and comfort.
Main Methods:
- A multicenter, prospective, randomized controlled, single-blind crossover trial.
- Adult patients with ARF receiving NIV were randomized to IS+ or conventional synchronization.
- The primary outcome was the Asynchrony Index (AI), measured over 30-minute periods.
Main Results:
- IS+ significantly reduced the total Asynchrony Index (AI) compared to conventional synchronization (11.8 vs. 25.5 events/100 breaths, p < 0.001).
- Both major and minor asynchrony indices were significantly lower with IS+.
- Dyspnea scores were significantly reduced with IS+, indicating improved patient comfort (3 ± 1 vs. 5 ± 1, p = 0.0001).
Conclusions:
- Closed-loop synchronization with IS+ effectively improves patient-ventilator interaction during NIV in ARF.
- IS+ enhances synchrony and patient comfort without adverse events or invasive monitoring.
- Real-time waveform analysis via a closed-loop algorithm can optimize NIV synchrony.
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