RCT

ACTiVE

Effect of Automated Closed-Loop Ventilation vs Protocolized Conventional Ventilation on Ventilator-Free Days in Critically Ill Adults

JAMA, 2026 · International multicenter randomized clinical trial (n=1201 modified intention-to-treat)

Clinical question

Does early automated closed-loop ventilation improve ventilator-free days?

Population: Critically ill adults early after invasive ventilation expected to require at least 24 hours
Intervention: INTELLiVENT adaptive support ventilation
Comparator: Protocolized conventional ventilation
Primary outcome: Ventilator-free days at day 28
Result: Median ventilator-free days were 16.7 vs 16.3; the difference was not statistically significant (P=0.23). Mortality and duration of ventilation were similar.

What the trial found

Automated closed-loop ventilation did not improve patient-centered liberation outcomes compared with protocolized conventional ventilation.

Current guideline position

Conventional or automated modes should still follow lung-protective targets, close monitoring and structured liberation.

Clinical interpretation

Automation can improve process measures but should not be presented as proven to reduce ventilation duration or mortality.

Clinical Context & Relevant Topics (1)

Disease Reference

Invasive Mechanical Ventilation

Complete clinical topic overview. For the full 10-level interactive course, visit Master MV. Covers core ventilator modes, respiratory mechanics (Cstat, Raw, driving pressure), waveform dyssynchrony analysis, VILI prevention, and liberation protocols.

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