Automatic Tube Compensation vs. Pressure Support Ventilation for Weaning From Mechanical Ventilation

Overseen By Lauren Harnois, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Rush University Medical Center

Disqualifiers: Tracheostomy, Pregnancy, Prisoner, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: Up to 30 days

880 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine which method better assists critically ill patients in breathing independently after using a breathing machine for more than 24 hours. It compares two techniques: pressure support ventilation (PSV), which provides a slight push to aid breathing, and automatic tube compensation (ATC), which makes breathing feel more natural. The study seeks patients who have been in an intensive care unit (ICU), have been on mechanical ventilation for at least a day, and are ready to attempt independent breathing. As an unphased trial, this study offers a unique opportunity to contribute to important research that could enhance breathing support techniques for future patients.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these methods are safe for weaning from mechanical ventilation?

Previous studies have shown that Automatic Tube Compensation (ATC) is safe and reliable for helping patients breathe independently again. Research indicates that ATC can be used in intensive care without causing harm and may reduce the time needed for patients to stop using breathing machines.

Pressure Support Ventilation (PSV) has also been studied. Research shows that it is safe and can assist in removing breathing tubes from patients. Many patients have successfully completed breathing tests using PSV, suggesting it is well-tolerated.

Both ATC and PSV have been extensively studied in intensive care units, and evidence supports their safe use in helping patients discontinue mechanical ventilators. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial of Automatic Tube Compensation (ATC) and Pressure Support Ventilation (PSV) for weaning patients from mechanical ventilation because these methods offer potentially smoother transitions from machine-assisted breathing to independent breathing. Unlike traditional weaning methods, ATC automatically adjusts for the resistance caused by the breathing tube, making it easier for patients to breathe naturally. PSV, on the other hand, provides just enough pressure to support the patient’s breathing effort, reducing the work of breathing and potentially speeding up recovery. This trial aims to find out which method is more effective and could lead to improved outcomes in intensive care units.

What evidence suggests that this trial's treatments could be effective for weaning from mechanical ventilation?

This trial will compare Automatic Tube Compensation (ATC) and Pressure Support Ventilation (PSV) for weaning patients from mechanical ventilation. Research has shown that both ATC and PSV effectively help patients stop using mechanical ventilators. Studies have found that ATC performs as well as PSV in predicting successful breathing tube removal. ATC is safe and may even shorten the weaning process. Conversely, PSV is particularly effective for patients who are easier to wean and usually results in fewer instances of reintubation. Both methods show promise in helping patients breathe independently after ventilator use. ^{2 4 6 7 8}

Are You a Good Fit for This Trial?

This trial is for critically ill adults who've been on mechanical ventilation for over 24 hours and are undergoing tests to see if they can breathe without the machine. Specific criteria for joining or reasons why someone might not be allowed in the study aren't provided.

Inclusion Criteria

I am 18 years old or older.

Requiring invasive mechanical ventilation for at least 24 hours

I passed a test that shows I can breathe on my own.

Exclusion Criteria

Enrolled in another clinical trial that impacts ventilator weaning or liberation

Do not intubate (DNI) order

Presence of tracheostomy

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo spontaneous breathing trials using either pressure support ventilation (PSV) or automatic tube compensation (ATC) to determine readiness for extubation

Up to 30 days

Follow-up

Participants are monitored for successful extubation and any ventilator-associated complications

Up to 30 days

What Are the Treatments Tested in This Trial?

Interventions

• Automatic Tube Compensation
• Pressure Support Ventilation

Trial Overview The study compares two methods of helping patients transition off mechanical breathing support: Automatic Tube Compensation (ATC) and Pressure Support Ventilation (PSV). It aims to find out which method is better at allowing successful removal of the breathing tube.

How Is the Trial Designed?

Group I: Neuroscience Intensive Care Unit (NSICU) Experimental Treatment 2 Interventions

Group II: Medical Intensive Care Unit (MICU) Experimental Treatment 2 Interventions

Group III: Cardiosciences Intensive Care Unit (CSICU) Experimental Treatment 2 Interventions

Group IV: Adult Intensive Care Unit (AICU) Experimental Treatment 2 Interventions

Who Is Running the Clinical Trial?

Rush University Medical Center

Lead Sponsor

Trials

448

Recruited

247,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2688139/

Prediction of extubation outcome: a randomised, controlled ... In this prospective, randomised study we have shown that the use of ATC was at least as effective as PSV in predicting successful extubation outcome after a ...

2. academic.oup.com academic.oup.com/qjmed/article/114/Supplement_1/hcab086.065/6379253

Comparative Study between Automatic Tube Compensation ... In ICU population, ATC was safe, reliable, and can be reasonably used for weaning trials. ATC confers a potential benefit in weaning duration, ...

3. frontiersin.org frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.731196/full

A Systematic Review and Network Meta-Analysis ATC (mode D) in the four entire networks showed 26.4% and 24.3% for weaning success, 32.7% and 23.9% for reintubation, 31.0% and 18.5% for SBT success, 29.5% ...

4. journal.chestnet.org journal.chestnet.org/article/S0012-3692(16)36217-1/fulltext

Automatic Tube Compensation Versus Pressure Support ... The primary outcomes measure was the ability to maintain spontaneous breathing for more than 48 hours after extubation and weaning duration.

5. clinicaltrials.gov clinicaltrials.gov/study/NCT00400881

Study Details | NCT00400881 | Comparison Between Two ... Study Overview. To compare a new mode of mechanical ventilation, Automatic Tube Compensation (ATC) with a traditional one, Continuous Positive Airway Pressure( ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8647911/

Comparative Efficacy and Safety of Four Different ... Among six direct comparisons in direct random-effects meta-analysis, ATC was associated with increased weaning success rate compared with T-piece (OR, 0.28; 95% ...

7. academic.oup.com academic.oup.com/qjmed/article-abstract/114/Supplement_1/hcab086.065/6379253

Comparative Study between Automatic Tube Compensation ... In ICU population, ATC was safe, reliable, and can be reasonably used for weaning trials. ATC confers a potential benefit in weaning duration, ...

8. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2815445

Spontaneous Breathing Trial Techniques for Extubating ... Limited data showed that patients who underwent ATC and CPAP compared with PS SBTs had a significantly higher successful extubation rate.