BiRDS
Trial question
What is the role of pressure control plus spontaneous ventilation in patients with ARDS?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
31.0% female
69.0% male
N = 699
699 patients (218 female, 481 male).
Inclusion criteria: adult patients with moderate or severe ARDS.
Key exclusion criteria: suspected or confirmed increased ICP; sickle cell disease; severe chronic respiratory disease requiring long-term oxygen therapy or home mechanical ventilation; severe burns; severe chronic liver disease; bone marrow transplant or chemotherapy-induced neutropenia; pneumothorax; expected duration of mechanical ventilation < 48 hours.
Interventions
N=347 pressure control plus spontaneous ventilation (sedation and/or ventilator settings adjusted to maintain the objective of spontaneous ventilation, modifying either minute ventilation or sedation).
N=352 volume assist-control ventilation (daily assessment of patient-ventilator asynchronies based on simple definitions recommended to further adapt sedation and/or ventilator settings).
Primary outcome
Death in hospital at day 60
34.6%
33.5%
34.6 %
26.0 %
17.3 %
8.7 %
0.0 %
Pressure control plus spontaneous
ventilation
Volume assist-control
ventilation
No significant
difference ↔
No significant difference in death in the hospital at day 60 (34.6% vs. 33.5%; RR 1.03, 95% CI 0.84 to 1.27).
Secondary outcomes
No significant difference in the rate of death in the first 28 days (25.1% vs. 22.4%; RR 1.12, 95% CI 0.86 to 1.46).
No significant difference in duration of mechanical ventilation (11.8 days vs. 12.2 days; AD -0.4 days, 95% CI -1.6 to 0.9).
Significant decrease in use of adjunctive therapy (33.1% vs. 41.3%; RR 0.8, 95% CI 0.66 to 0.98).
Conclusion
In adult patients with moderate or severe ARDS, pressure control plus spontaneous ventilation was not superior to volume assist-control ventilation with respect to death in the hospital at day 60.
Reference
Jean-Christophe M Richard, François M Beloncle, Gaëtan Béduneau et al. Pressure control plus spontaneous ventilation versus volume assist-control ventilation in acute respiratory distress syndrome. A randomised clinical trial. Intensive Care Med. 2024 Oct;50(10):1647-1656.
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