Automatic Tube Compensation vs. Pressure Support Ventilation During Spontaneous Breathing Trials in Adults

June 30, 2026 updated by: Jie Li, Rush University Medical Center

Automatic Tube Compensation vs. Pressure Support Ventilation During Spontaneous Breathing Trials in Critically Ill Adults: A Cluster-Randomized, Cluster-Crossover Trial

For patients requiring mechanical ventilation, spontaneous breathing trials (SBTs) are conducted to determine if it is safe to remove the breathing tube. There are multiple methods for conducting SBTs. The purpose of this study is to compare the effects of 2 methods, pressure support ventilation (PSV) versus automatic tube compensation (ATC), on successful extubation for critically ill adult patients who received mechanical ventilation for over 24 hours.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

The delivery of pressure support through the ventilator can be fixed using the pressure support ventilation (PSV) mode or variable using the automatic tube compensation (ATC) mode. Similar to PSV, ATC provides pressure support but dynamically adjusts it to compensate the resistive work of breathing and the mechanical load on respiratory muscles imposed by an artificial airway, such as an endotracheal or tracheostomy tube. Although both ATC and PSV are licensed and used in clinical practice, the optimal method to deliver pressure support during a spontaneous breathing trial (SBT) remains unknown. At Rush University Medical Center, ATC has been used for SBTs for over a decade. However, given the growing popularity of PSV, the SBT protocol was updated and now approves the use of PSV and ATC as standard care for SBT without making a recommendation for a preferred mode. The choice between PSV and ATC during SBT is left to the discretion of the clinician, reflecting the ongoing equipoise in the conduct of the SBT. As patients will be exposed to the potential benefits and risks of PSV or ATC under this change in clinical practice, the investigators are conducting a cluster-randomized cluster-crossover trial to compare the mode's effect on successful extubation.

Study Type

Interventional

Enrollment (Estimated)

880

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United States
    • Illinois
      • Chicago, Illinois, United States, 60612
        • Recruiting
        • Rush University Medical Center
        • Contact:
        • Contact:
        • Sub-Investigator:
          • Lauren Harnois, MS

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Admitted to intensive care unit (ICU)
  • Age 18 years or older
  • Requiring invasive mechanical ventilation for at least 24 hours
  • Pass spontaneous breathing trial screen criteria

Exclusion Criteria:

  • Clinical decision made not to proceed with extubation regardless of spontaneous breathing trial (SBT) results
  • Do not intubate (DNI) order
  • Presence of tracheostomy
  • Pregnancy
  • Known prisoner
  • Immediate need for extubation, self-extubation, or unplanned extubation that precludes safe performance of study procedures
  • Enrolled in another clinical trial that impacts ventilator weaning or liberation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Adult Intensive Care Unit (AICU)
Other: Pressure Support Ventilation (PSV)
Spontaneous breathing trials will be conducted using the mode pressure support ventilation (PSV) with settings of a pressure support of 5 cmH2O and positive end expiratory pressure (PEEP) 5 cmH2O.
Other: Automatic tube compensation (ATC)
Spontaneous breathing trials will be conducted using the mode automatic tube compensation (ATC) with settings of 100% tube compensation and a positive end expiratory pressure (PEEP) of 5 cmH2O.
Experimental: Medical Intensive Care Unit (MICU)
Other: Pressure Support Ventilation (PSV)
Spontaneous breathing trials will be conducted using the mode pressure support ventilation (PSV) with settings of a pressure support of 5 cmH2O and positive end expiratory pressure (PEEP) 5 cmH2O.
Other: Automatic tube compensation (ATC)
Spontaneous breathing trials will be conducted using the mode automatic tube compensation (ATC) with settings of 100% tube compensation and a positive end expiratory pressure (PEEP) of 5 cmH2O.
Experimental: Cardiosciences Intensive Care Unit (CSICU)
Other: Pressure Support Ventilation (PSV)
Spontaneous breathing trials will be conducted using the mode pressure support ventilation (PSV) with settings of a pressure support of 5 cmH2O and positive end expiratory pressure (PEEP) 5 cmH2O.
Other: Automatic tube compensation (ATC)
Spontaneous breathing trials will be conducted using the mode automatic tube compensation (ATC) with settings of 100% tube compensation and a positive end expiratory pressure (PEEP) of 5 cmH2O.
Experimental: Neuroscience Intensive Care Unit (NSICU)
Other: Pressure Support Ventilation (PSV)
Spontaneous breathing trials will be conducted using the mode pressure support ventilation (PSV) with settings of a pressure support of 5 cmH2O and positive end expiratory pressure (PEEP) 5 cmH2O.
Other: Automatic tube compensation (ATC)
Spontaneous breathing trials will be conducted using the mode automatic tube compensation (ATC) with settings of 100% tube compensation and a positive end expiratory pressure (PEEP) of 5 cmH2O.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Reintubation
Time Frame: Within 48 hours of extubation
Within 48 hours of extubation
Death
Time Frame: Within 48 hours of extubation
Within 48 hours of extubation

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mortality
Time Frame: Up to 30 days
Up to 30 days
Time to successful extubation
Time Frame: From the start of the first spontaneous breathing trial (SBT) to the first successful extubation (without reintubation within 48 hours) or death from any cause, whichever occurred first, assessed up to 30 days.
The duration (in hours) from the spontaneous breathing trial (SBT) initiation to extubation without reintubation within 48 hours
From the start of the first spontaneous breathing trial (SBT) to the first successful extubation (without reintubation within 48 hours) or death from any cause, whichever occurred first, assessed up to 30 days.
Spontaneous breathing trial (SBT) results
Time Frame: Up to 30 days from study enrollment or until hospital discharge, whichever occurs first.
SBT results (pass or fail) for the first 3 attempts if conducted
Up to 30 days from study enrollment or until hospital discharge, whichever occurs first.
Reintubation
Time Frame: within 24 hours of extubation
within 24 hours of extubation
Reintubation
Time Frame: Within 72 hours of extubation
Within 72 hours of extubation
Reintubation
Time Frame: Within 7 days of extubation
Within 7 days of extubation
Use of noninvasive respiratory support
Time Frame: Within 48 hours of extubation
Use of noninvasive ventilation, continuous positive airway pressure (CPAP), and high flow nasal cannula (HFNC) and its duration
Within 48 hours of extubation
Total duration of mechanical ventilation
Time Frame: From the date of intubation to the date of extubation without reintubation within 28 hours or date of death from any cause, whichever occurs first, assessed up to 30 days.
From the date of intubation to the date of extubation without reintubation within 28 hours or date of death from any cause, whichever occurs first, assessed up to 30 days.
Intensive care unit (ICU) length of stay (LOS)
Time Frame: From the date of ICU admission to the date of ICU discharge, assessed up to 30 days.
From the date of ICU admission to the date of ICU discharge, assessed up to 30 days.
Hospital length of stay (LOS)
Time Frame: From the date of hospital admission to the date of hospital discharge, assessed up to 30 days.
From the date of hospital admission to the date of hospital discharge, assessed up to 30 days.
Mortality
Time Frame: At intensive care unit (ICU) discharge
At intensive care unit (ICU) discharge
Clinician adherence to initially assigned spontaneous breathing trial (SBT) mode
Time Frame: Up to 30 days
Up to 30 days
Ventilator associated complications
Time Frame: From the date of intubation to the date of extubation without reintubation in 48 hours or death from any cause, whichever occurs first, assessed up to 30 days.
Including ventilator associated pneumonia, skin pressure ulcers, and barotrauma such as pneumothorax, pneumomediastinum, or subcutaneous emphysema
From the date of intubation to the date of extubation without reintubation in 48 hours or death from any cause, whichever occurs first, assessed up to 30 days.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Rush University Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 1, 2025

Primary Completion (Estimated)

July 1, 2027

Study Completion (Estimated)

August 1, 2027

Study Registration Dates

First Submitted

May 19, 2025

First Submitted That Met QC Criteria

May 27, 2025

First Posted (Actual)

June 5, 2025

Study Record Updates

Last Update Posted (Actual)

July 2, 2026

Last Update Submitted That Met QC Criteria

June 30, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 25031208

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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