Table 3 Characteristics and outcomes of the included trials in Part B
First author | Published year | Study design | Study location | Number of participants | Inclusion criteria | Intervention/comparison | Observation duration | Outcome | Results |
|---|---|---|---|---|---|---|---|---|---|
Thille | 2008 | Non-randomized interventional study | France | 12 | Intubated patients with greater than 10% ineffective breaths while receiving PSV | 1) Baseline: without PEEP and after application of 5 cm H2O of external PEEP 2) Gradual decrease in pressure-support level 3) Gradual reduction in insufflation time | 10 min | Asynchrony index | Optimization of the pressure-support level decreased the asynchrony index from 45% (36%–52%) to 0% (0%–7%, P < 0.01). Reducing the insufflation time decreased the asynchrony index from 45% (36%–52%) to 7% (3%–15%, P < 0.01) |
Doorduin | 2015 | Randomized cross-over trial | Netherlands | 12 | Patients with ARDS who received mechanical ventilation | 1) PCV 2) PSV 3) NAVA | 30 min | Dyssynchrony | Percentage of dyssynchrony breaths was significantly higher with PCV than with PSV. |
Figueroa-Casas | 2016 | Non-randomized interventional study | United States | 19 | Patients with ARDS who received mechanical ventilation for less than 72 hours, with expectation to continue it for at least 48 hours | 1) On volume assist control mode, each with set tidal volume of 6, 7.5, and 9 ml/kg predicted body weight, respectively 2) On adaptive pressure-control mode, each with the same sizes of set tidal volume | 10 min | Dyssynchrony index | In volume control mode, the median (interquartile range) DIs were 100% (22%–100%) at set VT of 6 ml/kg, and 78% (7%–100%) at 7.5 ml/kg, both higher than 25% (0%–45%) at 9 ml/kg (P = 0.02 and 0.01, respectively) In adaptive pressure-control mode, compared with volume control mode, the DIs were lower at set VT of 6 and 7.5 ml/kg (P = 0.004 for both) |
Luo | 2015 | Randomized controlled trial | China | 40 | Patients with ARDS who received mechanical ventilation | 1) SIMV + PS 2) ACV | From 24 hours after intubation to spontaneous breathing trial | Patient–ventilator asynchrony Duration of mechanical ventilation Hospital mortality | Percentage of patient–ventilator asynchrony, duration of mechanical ventilation and hospital mortality did not differ significantly between the two groups |
Bassuoni | 2012 | Randomized controlled trial | Egypt | 230 | Patients who expected to require invasive mechanical ventilation for more than 48 h on admission to the surgical intensive care | 1) Daily interruption of sedation 2) No sedation | Throughout mechanical ventilation | Asynchrony index | No sedation was associated with significantly lower asynchrony index |
Conti | 2016 | Randomized controlled trial | Italy | 26 | Adult ICU patients who had failed one weaning trial | 1) Dexmedetomidine 2) Propofol to maintain the RASS score within the range of + 1 to –2 | Over 10 min | Asynchrony index | Mean AI was lower with dexmedetomidine than with propofol from 2 h onwards, although the two groups only differed significantly only at 12 h (2.68 % vs 9.10 %, P < 0.05) |
Vaschetto | 2014 | Randomized cross-over trial | Italy | 14 | Intubated patients undergoing partial ventilatory support for a period less than or equal to 48 hours | 1) No sedative infusion (patient awake) 2) Deep sedation, achieved by setting the propofol target blood concentration to obtain a BIS value of 40 3) Light sedation, corresponding to half the propofol target blood concentration used to achieve a BIS value of 40 | 25 min | Ineffective trigger index | In PSV, ITI did not differ significantly between wakefulness and light sedation (5.9% and 7.6%, respectively, P = 0.97), but significantly increased up to 21.8% with deep sedation (P < 0.0001 vs both wakefulness and light sedation) |
Chanques | 2013 | Non-randomized interventional study | United States | 30 (100 sequences) | Patients receiving mechanical ventilation if they had severe breath stacking defined as asynchrony index > 10% | 1) No intervention 2) Increase in sedation-analgesia 3) Change in ventilator setting | 5–30 min | Breath stacking Asynchrony index | Compared with baseline, the decrease of asynchrony index was greater after changing the ventilator setting (–99% [–92%, –100%]) than after increasing the sedation-analgesia (–41% [–66%, 7%], P < 0.001) or deciding to tolerate the asynchrony (4% [–4%, 12%], P < 0.001) Pressure-support ventilation and increased inspiratory time were independently associated with the reduction in asynchrony index |