Critically ill patients in intensive care units often require mechanical ventilation to support their breathing. Physicians typically choose between different ventilation modes, including a widely used standard that delivers the same level of assistance at all times. However, prolonged sedation and delirium during ventilation can lead to long-term psychological and cognitive issues. Improving patient well-being and reducing the risks associated with sedation and delirium remains a significant challenge. A new ventilation method was tested to determine if adjusting breathing support to meet individual patient needs could improve outcomes. The approach was found to reduce sedation duration and delirium rates, offering potential benefits even though it did not significantly shorten the overall time patients remained on ventilation.

The study was led by the London Health Sciences Centre Research Institute (LHSCRI, London, ON, Canada) and St. Michael’s Hospital (Toronto, ON, Canada), and focused on a new ventilation mode known as proportional assist ventilation (PAV+). The PAV+ mode differs from the standard pressure support ventilation by personalizing breathing support based on the patient's respiratory effort. The aim was to assess whether this newer mode could reduce the time patients needed mechanical ventilation. A total of 722 ICU patients were enrolled in the seven-year international, multi-center clinical trial, with 573 randomly assigned to either PAV+ or the standard mode. Researchers then monitored the patients for various outcomes, including the duration of ventilation, the use of sedative drugs, and the presence of delirium during treatment.

Published in the New England Journal of Medicine, the study found that the median duration on ventilation was 7.3 days for patients using PAV+ compared to 6.8 days for those on standard ventilation. While the difference in ventilation duration was not significant, meaningful clinical improvements were observed. Patients in the PAV+ group had fewer days of delirium—23% compared to 26%—and showed a faster reduction in the use of sedative medications. These results highlight the importance of personalized ventilation settings in improving ICU care. Looking ahead, the research team plans to analyze the large dataset collected during the trial using artificial intelligence (AI) to further understand how PAV+ might minimize complications associated with long-term ventilation.

“This is one of the largest ventilation studies to date examining these two modes of ventilation, and over the last seven years we have gathered a lot of crucial data on critically ill patients on a ventilator,” said LHSCRI scientist Dr. Karen Bosma. “Future research will use artificial intelligence to analyze this data helping us better understand PAV+TM and how it may minimize specific health consequences associated with prolonged ventilation.”

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