Closed-loop versus conventional synchronization in spontaneously breathing adult patients- a randomized controlled study
In brief
Closed-loop NIV algorithm halves patient-ventilator asynchrony events
In a crossover trial of adults with acute respiratory failure, the IntelliSync+ closed-loop system reduced the asynchrony index from roughly 26 to 12 events per 100 breaths, cutting total asynchrony by about 55%. Patients also reported lower dyspnea scores, and no adverse events occurred, suggesting the algorithm improves comfort and synchrony during noninvasive ventilation.
- Journal
- Journal of critical care (Q1)
- Published
- 14 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ramazan Guven, Cenk Kirakli, Jean-Pierre Revely, Mustafa Colak, Tuba Dogan, Dominik Novotni, et al.
- PMID
- 42600333
- DOI
- 10.1016/j.jcrc.2026.155705
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 16 August 2026): Closed-loop NIV reduces asynchrony index in acute respiratory failure
Abstract
BACKGROUND: The IntelliSync+ [IS+] algorithm provides closed-loop synchronization by continuously analyzing airway pressure and flow waveforms in real time to optimize inspiratory and expiratory cycling. This study evaluated the efficacy of IS+ compared with conventional physician-tailored synchronization during noninvasive ventilation [NIV] in spontaneously breathing adult patients with ARF. METHODS: This multicenter, prospective, randomized controlled, single-blind crossover trial was conducted between March 2024 and May 2025 in two tertiary hospitals. Adult patients receiving NIV for ARF were randomized to start with either conventional synchronization or IS+. Each mode was applied for 30 min, separated by a 15-min washout period. The primary outcome was the Asynchrony Index [AI], defined as the number of asynchronous events per 100 breaths. RESULTS: Compared with conventional synchronization, IS+ significantly reduced the total AI [11.8 (7.9-22.4) vs. 25.5 (12.1-35.3) events/100 breaths, p < 0.001], as well as both major and minor asynchrony indices [8.3 (4.5-16.4) vs. 17.6 (7.5-25.6), p < 0.001; 3.4 (1.5-5.4) vs. 7.6 (3.4-13.6), p < 0.001, respectively]. Dyspnea scores were significantly reduced during IS+ [3 ± 1 vs. 5 ± 1, p = 0.0001], indicating improved comfort. CONCLUSIONS: Closed-loop synchronization using IS+ significantly improved patient-ventilator interaction and comfort during NIV in adults with acute respiratory failure with no adverse events observed during the study period. This study demonstrates that synchrony during NIV can be enhanced using a closed-loop algorithm alone, solely through real-time waveform analysis, without the need for additional invasive monitoring. Clinical Trials ID: NCT06357780.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.