Influence of ventilatory strategies on outcomes and length of hospital stay: assist-control and synchronized intermittent mandatory ventilation modes

Abstract

The use of synchronized intermittent mandatory ventilation with pressure support ventilation (SIMV + PSV) mode has been discontinued. This study analyzed the association between medical outcomes related to the use of assist-control (A/C) and SIMV + PSV in an intensive care unit. In this observational and retrospective study, modes of ventilation and medical data were collected from electronic medical records for three consecutive years and were related to medical outcomes (mortality), duration of mechanical ventilation, length of hospital stay and the need for tracheostomy. Participants were divided into groups according to the modes of ventilation: A/C and SIMV + PSV. Statistical analyses were performed in the R environment. Alpha = 0.05. The using chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests were used. 345 adult participants were included; 211/345 (61.16%) were males. Of the participants, 151/345 (43.77%) were on SIMV + PSV and 194/345 (56.23%) were on A/C. The comparative analysis between the modes of ventilation showed no significant differences in length of hospital stay (p = 0.675), duration of mechanical ventilation (p = 0.952), mortality (p = 0.241), failed extubation (p = 0.411) and the need for tracheostomy (p = 0.301). SIMV + PSV as a mode of ventilation showed similar statistical results to the A/C mode, when compared to analyzed medical outcomes.

Influence of ventilatory strategies on outcomes and length of hospital stay: assist control and synchronized intermittent mandatory ventilation modes

“…As shown in the article published by Thais Bruno de Godoi and colleagues [1], either mode can be used successfully for assisted ventilation, but one mode may be better than the other in some circumstances.…”

“…I read with interest the article published by Thais Bruno de Godoi and colleagues in the current issue of "Internal and Emergency Medicine" [1]. This single-center, observational, and retrospective study performed on 345 adult ICU patients shows that the mortality, duration of mechanical ventilation, length of hospital stay, failed extubation, and need for tracheostomy are statistically similar between the synchronized intermittent mandatory ventilation with pressure support ventilation (SIMV + PSV) mode and the assist-control (A/C) mode.…”

“…Based on the results of the study by Thais Bruno de Godoi and colleagues [1], I will not change my clinical practice of selecting the A/C mode in critically ill, mechanically ventilated patients in the ICU, but I congratulate the authors for conducting another of a handful of studies [13][14][15] comparing outcomes of patients ventilated with A/C mode or intermittent mandatory ventilation (IMV) mode under nonweaning conditions.…”