Outcomes of patients ventilated with synchronized intermittent mandatory ventilation with pressure support: A comparative propensity score study

Guillermo Ortiz, Fernando Frutos-Vivar, Niall D. Ferguson, Andrés Esteban, Konstantinos Raymondos, Carlos Apezteguía, Javier Hurtado, Marco González, Vinko Tomicic, José Elizalde, Fekri Abroug, Yaseen Arabi, Paolo Pelosi, Antonio Anzueto

    Research output: Contribution to journalArticle in an indexed scientific journalpeer-review

    25 Scopus citations

    Abstract

    Background: Few data are available regarding the benefits of one mode over another for ventilatory support. We set out to compare clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support. Methods: This was a secondary analysis of an observational study conducted in 349 ICUs from 23 countries. A propensity score stratified analysis was used to compare 350 patients ventilated with SIMV-PS with 1,228 patients ventilated with A/C ventilation. The primary outcome was in-hospital mortality. Results: In a logistic regression model, patients were more likely to receive SIMV-PS if they were from North America, had lower severity of illness, or were ventilated postoperatively or for trauma. SIMV-PS was less likely to be selected if patients were ventilated because of asthma or coma, or if they developed complications such as sepsis or cardiovascular failure during mechanical ventilation. In the stratified analysis according to propensity score, we did not find significant differences in the in-hospital mortality. After adjustment for propensity score, overall effect of SIMV-PS on in-hospital mortality was not significant (odds ratio, 1.04; 95% CI, 0.77-1.42; P 5.78). Conclusions: In our cohort of ventilated patients, ventilation with SIMV-PS compared with A/C did not offer any advantage in terms of clinical outcomes, despite treatment-allocation bias that would have favored SIMV-PS.

    Original languageEnglish
    Pages (from-to)1265-1277
    Number of pages13
    JournalChest
    Volume137
    Issue number6
    DOIs
    StatePublished - 1 Jun 2010

    Bibliographical note

    Funding Information:
    Funding/Support: This study was funded by CIBER Enfermedades Respiratorias from Instituto de Salud Carlos III, Spain. Dr Ferguson is supported by a Canadian Institutes of Health Research New Investigator Award (Ottawa, ON, Canada).

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