What question did this study set out to answer?

This study aims to compare the efficacy of a closed-loop synchronization algorithm with conventional synchronization in pediatric patients undergoing mechanical ventilation.

March 29, 2026Open Access

Closed-loop synchronization versus conventional synchronization in spontaneously breathing pediatric patients (CHESTSIPP) – a randomized controlled cross-over study

Key Points

This study aims to compare the efficacy of a closed-loop synchronization algorithm with conventional synchronization in pediatric patients undergoing mechanical ventilation.
Conducted as a multicenter, prospective, randomized controlled, single-blind crossover trial.
Involved four pediatric intensive care units from March 2024 to May 2025.
Patients aged 1 month to 18 years were randomized to receive either closed-loop or conventional synchronization.
Each mode was administered for 90 minutes with a washout period in between.
Closed-loop synchronization significantly reduced the overall asynchrony index compared to conventional synchronization.
Major and minor asynchrony indices showed significant improvement.
Comfort scores improved mildly, while end-tidal carbon dioxide levels decreased significantly.
Oxygen saturation and leak percentage remained stable throughout the study.

Abstract

Background Patient–ventilator asynchrony (PVA) is common during invasive mechanical ventilation in children and may increase respiratory workload and discomfort. The IntelliSync+ (IS+) algorithm provides closed-loop synchronization by continuously analyzing airway pressure and flow waveforms to optimize inspiratory and expiratory cycling in real time. This study evaluated the efficacy and safety of IS+ compared with conventional physician-tailored synchronization in spontaneously breathing pediatric patients. Methods Multicenter, prospective, randomized controlled, single-blind crossover trial conducted in four pediatric intensive care units between March 2024 and May 2025. Patients aged 1 month to 18 years undergoing invasive mechanical ventilation were randomized to begin with either IS+ or conventional synchronization. Each mode was applied for 90 min (30-min run-in and 60-min measurement), separated by a 30-min washout period. The primary outcome was the Asynchrony Index (AI). Secondary outcomes included major and minor asynchrony indices, Comfort-B scores, end-tidal carbon dioxide (EtCO 2 ), oxygen saturation (SpO 2 ), and leak percentage. Findings Twenty-five patients completed both study phases. Compared with conventional synchronization, IS+ significantly reduced the overall AI (median 5.1% IQR 4.2–6.4 vs. 12.4% IQR 9.9–15.6; P 0.001), as well as both major and minor asynchrony indices ( P 0.001 for both). The frequencies of double triggering, auto-triggering, trigger delay, and early cycling decreased significantly, while ineffective efforts were unchanged and late cycling slightly increased. Comfort-B scores improved modestly ( P = 0.02) and EtCO 2 decreased ( P 0.001), whereas SpO 2 and leak remained stable. Conclusion Closed-loop synchronization with IS+ significantly improved patient–ventilator interaction without compromising comfort, oxygenation, or safety. These results support closed-loop synchronization as a feasible and physiologically sound strategy for improving ventilatory support quality in pediatric invasive mechanical ventilation. Clinical trial registration ClinicalTrials.gov , identifier NCT05731024.

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Cite This Study

Ceylan et al. (Wed,) studied this question.

synapsesocial.com/papers/69c8c0b0de0f0f753b39b853 https://doi.org/https://doi.org/10.3389/fmed.2026.1745939

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