{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:17:54Z","timestamp":1787026674820,"version":"build-2736575974"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patient\u2013ventilator asynchrony (PVA) is common during invasive mechanical ventilation in children and may increase respiratory workload and discomfort. The IntelliSync+ (IS+) algorithm provides closed-loop synchronization by continuously analyzing airway pressure and flow waveforms to optimize inspiratory and expiratory cycling in real time. This study evaluated the efficacy and safety of IS+ compared with conventional physician-tailored synchronization in spontaneously breathing pediatric patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Multicenter, prospective, randomized controlled, single-blind crossover trial conducted in four pediatric intensive care units between March 2024 and May 2025. Patients aged 1 month to 18 years undergoing invasive mechanical ventilation were randomized to begin with either IS+ or conventional synchronization. Each mode was applied for 90 min (30-min run-in and 60-min measurement), separated by a 30-min washout period. The primary outcome was the Asynchrony Index (AI). Secondary outcomes included major and minor asynchrony indices, Comfort-B scores, end-tidal carbon dioxide (EtCO\n                      <jats:sub>2<\/jats:sub>\n                      ), oxygen saturation (SpO\n                      <jats:sub>2<\/jats:sub>\n                      ), and leak percentage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Twenty-five patients completed both study phases. Compared with conventional synchronization, IS+ significantly reduced the overall AI (median 5.1% [IQR 4.2\u20136.4] vs. 12.4% [IQR 9.9\u201315.6];\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), as well as both major and minor asynchrony indices (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001 for both). The frequencies of double triggering, auto-triggering, trigger delay, and early cycling decreased significantly, while ineffective efforts were unchanged and late cycling slightly increased. Comfort-B scores improved modestly (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02) and EtCO\n                      <jats:sub>2<\/jats:sub>\n                      decreased (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), whereas SpO\n                      <jats:sub>2<\/jats:sub>\n                      and leak remained stable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Closed-loop synchronization with IS+ significantly improved patient\u2013ventilator interaction without compromising comfort, oxygenation, or safety. These results support closed-loop synchronization as a feasible and physiologically sound strategy for improving ventilatory support quality in pediatric invasive mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      [\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      ], identifier [NCT05731024].\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1745939","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:52:43Z","timestamp":1774421563000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Closed-loop synchronization versus conventional synchronization in spontaneously breathing pediatric patients (CHESTSIPP) \u2013 a 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