Aslam Tayyba Naz, Klitgaard Thomas Lass, Møller Morten Hylander, Perner Anders, Hofsø Kristin, Skrubbeltrang Conni, Rasmussen Bodil Steen, Laake Jon Henrik
Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Acta Anaesthesiol Scand. 2025 Sep;69(8):e70096. doi: 10.1111/aas.70096.
Mechanically ventilated patients with acute respiratory distress syndrome (ARDS) can be managed using either controlled or spontaneous (assisted) breathing modes. While both approaches are used in clinical practice, the proportion of patients receiving mechanical ventilation that allows for spontaneous breaths and the impact of this strategy on patient outcomes remain unclear. This scoping review aimed to map and summarise the scope, range and nature of the evidence for assisted versus controlled breathing in mechanically ventilated patients with ARDS, including identification of research gaps.
We conducted a scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We searched PubMed, CINAHL, Embase and the Cochrane Library for literature on controlled versus spontaneous breathing in mechanically ventilated patients with ARDS, irrespective of severity. Studies reporting qualitative and/or quantitative data from any world region were included. Where relevant, we performed meta-analyses to summarise data, and we assessed the overall quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
Our search was completed on May 13, 2025. We identified 6827 titles, with 1193 studies assessed in full text. A total of 564 studies were included in the final review, comprising 114 clinical trials, 267 observational studies, as well as case reports, conference abstracts and surveys. Both invasive and non-invasive ventilation techniques were described. Patient-important outcomes were limited to short- and long-term survival, duration of mechanical ventilation, length of stay and complications (e.g., pneumothorax). Patient-reported long-term outcomes were rarely reported. The evidence does not conclusively favour either spontaneous or controlled mechanical ventilation.
Our scoping review identifies extensive documentation of widespread use of spontaneous breathing techniques, with both invasive and non-invasive ventilation, in patients with ARDS. Despite data from several large observational studies and one large randomised clinical trial, the benefits and harms of spontaneous versus controlled ventilation remain unclear. The near absence of long-term, patient-reported outcomes defines an important research gap.
This systematic review addresses current evidence concerning whether or not spontaneous ventilation with support or assistance is more advantageous for critically ill ventilator-dependent ARDS cases versus passive positive pressure ventilatory support. To distinguish and separate these 2 approaches in critical care treatment is challenging, and this review nicely presents the current state of evidence for this field, including knowledge gaps.
急性呼吸窘迫综合征（ARDS）的机械通气患者可采用控制呼吸模式或自主（辅助）呼吸模式进行管理。虽然这两种方法都在临床实践中使用，但接受允许自主呼吸的机械通气的患者比例以及该策略对患者预后的影响仍不明确。本范围综述旨在梳理和总结ARDS机械通气患者辅助呼吸与控制呼吸的证据范围、广度和性质，包括识别研究空白。
我们根据系统评价和Meta分析的首选报告项目（PRISMA）扩展版进行了范围综述。我们在PubMed、CINAHL、Embase和Cochrane图书馆中搜索了关于ARDS机械通气患者控制呼吸与自主呼吸的文献，不考虑疾病严重程度。纳入了来自任何世界地区报告定性和/或定量数据的研究。在相关情况下，我们进行Meta分析以总结数据，并使用推荐分级评估、制定和评价（GRADE）方法评估证据的总体质量。
我们的检索于2025年5月13日完成。我们识别出6827个标题，对1193项研究进行了全文评估。最终综述纳入了564项研究，包括114项临床试验、267项观察性研究以及病例报告、会议摘要和调查。文中描述了有创和无创通气技术。对患者重要的结局仅限于短期和长期生存、机械通气时间、住院时间和并发症（如气胸）。很少报告患者自述的长期结局。证据并未明确支持自主呼吸或控制呼吸的机械通气。
我们的范围综述发现，有大量文献记录了ARDS患者广泛使用自主呼吸技术，包括有创和无创通气。尽管有来自几项大型观察性研究和一项大型随机临床试验的数据，但自主呼吸与控制呼吸通气的利弊仍不明确。几乎没有长期的、患者自述的结局，这界定了一个重要的研究空白。
本系统综述探讨了当前关于在依赖呼吸机的ARDS危重症病例中，有支持或辅助的自主通气与被动正压通气支持相比是否更具优势的证据。在重症监护治疗中区分和分离这两种方法具有挑战性，本综述很好地呈现了该领域的当前证据状态，包括知识空白。
