A Pragmatic Pilot Trial Comparing Patient-Triggered Adaptive Pressure Control to Patient-Triggered Volume Control Ventilation in Critically Ill Adults.

BACKGROUND: Patient-triggered adaptive pressure control (APC) continuous mandatory ventilation (CMV) (APC-CMV) has been widely adopted as an alternative ventilator mode to patient-triggered volume control (VC) CMV (VC-CMV). However, the comparative effectiveness of the 2 ventilator modes remains uncertain. We sought to explore clinical and implementation factors pertinent to a future definitive randomized controlled trial assessing APC-CMV versus VC-CMV as an initial ventilator mode strategy. The research objectives in our pilot trial tested clinician adherence and explored clinical outcomes. METHODS: In a single-center pragmatic sequential cluster crossover pilot trial, we enrolled all eligible adults with acute respiratory failure requiring mechanical ventilation admitted during a 9-week period to the medical ICU. Two-week time epochs were assigned a priori in which subjects received either APC-CMV or VC-CMV The primary outcome of the trial was feasibility, defined as 80% of subjects receiving the assigned mode within 1 h of initiation of ICU ventilation. The secondary outcome was proportion of the first 24 h on the assigned mode. Finally, we surveyed clinician stakeholders to understand potential facilitators and barriers to conducting a definitive randomized trial. RESULTS: We enrolled 137 subjects who received 152 discreet episodes of mechanical ventilation during time epochs assigned to APC-CMV (n = 61) and VC-CMV (n = 91). One hundred and thirty-one episodes were included in the prespecified primary outcome. One hundred and twenty-six (96%) received the assigned mode within the first hour of ICU admission (60 of 61 subjects assigned APC-CMV and 66 of 70 assigned VC-CMV). VC-CMV subjects spent a lower proportion of first 24 h (84% [95% CI 78-89]) on the assigned mode than APC-CMV recipients (95% [95% CI 91-100]). Mixed-methods analyses identified preconceived perceptions of subject comfort by clinicians and need for real-time education to address this concern. CONCLUSIONS: In this pilot pragmatic, sequential crossover trial, unit-wide allocation to a ventilator mode was feasible and acceptable to clinicians.

Rheology of cubic particles suspended in a Newtonian fluid.

Many real-world industrial processes involve non-spherical particles suspended in a fluid medium. Knowledge of the flow behavior of these suspensions is essential for optimizing their transport properties and designing processing equipment. In the present work, we explore and report on the rheology of concentrated suspensions of cubic-shaped colloidal particles under steady and dynamic shear flow. These suspensions exhibit a rich non-Newtonian rheology that includes shear thickening and normal stress differences at high shear stresses. Scalings are proposed to connect the material properties of these suspensions of cubic particle to those measured for suspensions of spherical particles. Negative first normal stress differences indicate that lubrication hydrodynamic forces dominate the stress in the shear-thickened state. Accounting for the increased lubrication hydrodynamic interactions between the flat surfaces of the cubic particles allows for a quantitative comparison of the deviatoric stress in the shear-thickened state to that of spherical particles. New semi-empirical models for the viscosity and normal stress difference coefficients are presented for the shear-thickened state. The results of this study indicate that cubic particles offer new and unique opportunities to formulate colloidal dispersions for field-responsive materials.