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Original Research: CRITICAL CARE MEDICINE |

Outcomes of Patients Ventilated With Synchronized Intermittent Mandatory Ventilation With Pressure Support: A Comparative Propensity Score Study

Guillermo Ortiz, MD; Fernando Frutos-Vivar, MD; Niall D. Ferguson, MD, MSc; Andres Esteban, MD, PhD; Konstantinos Raymondos, MD; Carlos Apezteguía, MD; Javier Hurtado, MD; Marco González, MD; Vinko Tomicic, MD; José Elizalde, MD; Fekri Abroug, MD; Yaseen Arabi, MD, FCCP; Paolo Pelosi, MD; Antonio Anzueto, MD; for the Ventila Group*
Author and Funding Information

From the Hospital de Santa Clara (Dr Ortiz), Bogotá, Colombia; Hospital Universitario de Getafe, and CIBER Enfermedades Respiratorias (Drs Frutos-Vivar and Esteban), Madrid, Spain; Interdepartmental Division of Critical Care Medicine and Department of Medicine (Dr Ferguson), Division of Respirology, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; Medizinische Hochschule (Dr Raymondos), Hannover, Germany; Hospital Profesor A. Posadas (Dr Apezteguía), El Palomar, Buenos Aires, Argentina; Hospital de Clínicas (Dr Hurtado), Montevideo, Uruguay; Clínica Medellín y Universidad Pontificia Bolivariana (Dr González), Medellín, Colombia; Clínica Alemana de Santiago (Dr Tomicic), Santiago, Chile; Hospital ABC (Dr Elizalde), México DF, México; Fattouma Bourguiba Monastir (Dr Abroug), Monastir, Tunisia; King Saud Bin Abdulaziz University for Health Sciences (Dr Arabi), Riyadh, Saudi Arabia; Ospedale di Circolo, Università degli Studi dell’Insubria (Dr Pelosi), Varese, Italy; and the South Texas Veterans Health Care System and University of Texas Health Science Center (Dr Anzueto), San Antonio, TX.

Correspondence to: Andrés Esteban, MD, PhD, Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo km, 12,500, 28905-Madrid, Spain; e-mail: aesteban@ucigetafe.com


A complete list of study participants is located in the Appendix.

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).

For editorial comment see page 1256

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1265-1277. doi:10.1378/chest.09-2131
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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 = .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.

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