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Ventilator-free DaysACTiVENCT04593810

Effect of Automated Closed-Loop Ventilation Versus Conventional Ventilation on Duration and Quality of Ventilation

A study testing INTELLiVENT-ASV and CONVENTIONAL VENTILATION in people with Ventilator-free Days and Quality of Breathing, run by Prof. Dr. Marcus J. Schultz at 10 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

INTELLiVENT-Adaptive Support Ventilation (ASV) is a fully automated closed-loop mode of mechanical ventilation available on commercial ventilators. Evidence for clinical benefit of INTELLiVENT-ASV in comparison to non-automated ventilation is lacking. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Ventilator-free Days, Quality of Breathing
What is being tested?
INTELLiVENT-ASV and CONVENTIONAL VENTILATION
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,201 participants
Where
10 sitesin 2 countries
Study dates
19 Oct 2020to 16 Sep 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • admission to one of the participating ICUs
  • intubated and receiving invasive ventilation
  • anticipated duration of ventilation of at least 24 hours

Who cannot join

  • age below 18 years
  • patients with suspected or confirmed pregnancy
  • invasive ventilation > 1 hour in the ICU
  • invasive ventilation > 6 hours directly preceding the current ICU admission
  • participation in another interventional trial using similar endpoints
  • after recent pneumectomy or lobectomy
Show all 14Show fewer
  • morbid obesity (body mass index > 40 kg/m2)
  • premorbid restrictive pulmonary disease
  • unreliable pulse oximetry (secondary to carbon monoxide poisoning or sickle cell disease)
  • any neurologic diagnosis that can prolong duration of mechanical ventilation, e.g., Guillain-Barré syndrome, high spinal cord lesion or amyotrophic lateral sclerosis, multiple sclerosis, or myasthenia gravis
  • patients receiving or planned to receive veno-venous, veno-arterial or arterio-venous extracorporeal membrane oxygenation (ECMO)
  • unavailability of INTELLiVENT-ASV (no ventilator available with this ventilation mode)
  • previously randomized in this study
  • no informed consent

Trial locations and contacts

10 sites in 2 countries.

10 sites in 2 countries

Netherlands8 sites
  • Flevoziekenhuis

    Almere Stad

  • Academic Medical Center, Intensive Care

    Amsterdam

  • Reinier de Graaf Gasthuis

    Delft

  • Catharina Ziekenhuis

    Eindhoven

  • Leiden UMC

    Leiden

  • Canisius-Wilhelmina Hospital

    Nijmegen

  • Elisabeth-TweeSteden Ziekenhuis

    Tilburg

  • Diakonessenhuis, Utrecht

    Utrecht

Other trials in Netherlands

Italy2 sites
  • Ospedale Policlinico San Martino

    Genoa

  • Policlinico San Matteo Fondazione IRCCS

    Pavia

Other trials in Italy

About this study

Official title: Effect of Automated Closed-Loop Ventilation Versus Conventional Ventilation on Duration and Quality of Ventilation ('ACTiVE') - a Randomized Clinical Trial in Intensive Care Unit Patients

INTELLiVENT-Adaptive Support Ventilation (ASV) is a fully automated closed-loop mode of mechanical ventilation available on commercial ventilators. Evidence for clinical benefit of INTELLiVENT-ASV in comparison to non-automated ventilation is lacking.

The ACTiVE study is an international, multicenter, randomized controlled trial in invasively ventilated ICU patients with the objective to compare INTELLiVENT-ASV to conventional ventilation. We hypothesise that INTELLiVENT-ASV shortens the duration of ventilation. The secondary hypothesis is that INTELLiVENT-ASV improves the quality of breathing.

Read the detailed description

Objective

The primary objective of this trial is to compare INTELLiVENT-ASV with non-automated ventilation in critically ill intensive care unit (ICU) patients with respect to ventilation duration. One secondary aim is to test whether INTELLiVENT-ASV improves quality of breathing, expressed as the proportion of breath within lung-protective margins, in a time frame of 24 hours early after start of invasive ventilation.

Study design

International, multicenter, superiority randomized clinical trial in critically ill, intubated and ventilated adult ICU patients with an anticipated duration of ventilation of at least 24 hours.

Study population

Adult patients admitted to ICUs in the Netherlands and Italy.

Sample size calculation

The sample size is based on the hypothesis that INTELLiVENT-ASV will shorten ventilation duration by 1.5 days with no changes in mortality rate. Based on previously performed studies a sample of 1,200 patients (600 in each treatment group) is needed to have beta of 80% power and a two-tailed alpha of 0.05, to detect a mean between-group difference of 1.5 VFD-28, allowing a dropout rate of 5%. By including 1,200 patients, this study will be sufficiently powered to detect differences in the secondary endpoint, which is quality of breathing.

Methods:

Within one hour of start of ventilation in the ICU, patients are randomly assigned in a 1:1 ratio to INTELLiVENT-ASV or non-automated ventilation. Randomization will be stratified by center. As soon as possible after randomization, but within a maximum of 72 hours, deferred consent is obtained from the legal representative of the patient.

INTELLiVENT-ASV In patients who are randomized to INTELLiVENT-ASV, the ventilator is switched to this fully automated mode as soon possible. The sensors for end-tidal carbon dioxide (ETCO2) and pulse oximetry (SpO2) are connected and activated in the ventilator. Patient's gender and height are set on the ventilator and patient condition is chosen if applicable. If needed, the targets zones for ETCO2 and SpO2 are adjusted. The default alarm limits are accepted.

It is advised to enable QuickWean in all patients. The use of the automated Spontaneous Breathing Trial (SBT) function is left to the discretion of the clinician.

CONVENTIONAL VENTILATION Patients who are randomized to conventional ventilation will be ventilated with a mode that is not fully automated, thus standard volume controlled (VCV) or pressure controlled ventilation (PCV), and pressure support ventilation (PSV), depending on patient's activity. None of the following semi or fully automated modes of ventilation is allowed at any time: Neurally Adjusted Ventilatory Assist (NAVA), SmartCare/PS, Proportional Assist Ventilation (PAV), or the predecessor of INTELLiVENT-ASV named ASV.

In all patients who receive assist ventilation (i.e., VCV or PCV), three times a day it should be checked whether the patient can accept supported ventilation (i.e., PSV); this should also be tried when the patient shows respiratory muscle activity during assist ventilation, or in case of patient-ventilator asynchrony.

Patients can be subjected to SBTs using either a T-piece or ventilation with minimal support (pressure support level < 10 cm H2O). An SBT is deemed successful when the following criteria are met for at least 30 minutes, i.e., respiratory rate < 35/min, peripheral oxygen saturation > 90%, increase < 20% of heart rate and blood pressure, and no signs of anxiety and diaphoresis.

In both groups patients are extubated if standard extubation criteria are fulfilled, i.e., normal body temperature, patient awake and responsive/cooperative, adequate cough reflex, adequate oxygenation, hemodynamically stable, and adequate lung function.

Being tested
INTELLiVENT-ASV, CONVENTIONAL VENTILATION
Keywords
Automated invasive ventilation, Closed-loop invasive ventilation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • INTELLiVENT-ASVProcedure or surgery

    INTELLiVENT-ASV is activated as soon possible. The sensors for ETCO2 and SpO2 are connected and activated. Patient's gender and height are set on the ventilator and patient condition is chosen if applicable.

  • CONVENTIONAL VENTILATIONProcedure or surgery

    Conventional ventilation consists of VCV or PCV and PSV, depending on patient's activity. None of the semi or fully automated modes of ventilation is allowed at any time.

Study groups in NCT04593810
Study groupRoleWhat they receive
INTELLiVENT-ASVExperimentalUse of INTELLIVENT-ASV after intubation and during all mechanical ventilation in the ICU.
Receives: Procedure: INTELLiVENT-ASV
Conventional ventilationActive comparatorUse of conventional ventilation after intubation and during all mechanical ventilation in the ICU.
Receives: Procedure: CONVENTIONAL VENTILATION

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Ventilator-free days and alive at day 28

    The number of days from day 1 to day 28 the patient is alive and breathes without assistance of the mechanical ventilator, if the period of unassisted breathing lasted at least 24 consecutive hours

    Measured: first 28 days after start of ventilation

Secondary outcomes (9)
  1. Quality of breathing

    Proportion of breaths within lung-protective margins

    Measured: 24 hours early after start of invasive ventilation.

  2. Duration of ventilation

    Duration of ventilation in survivors

    Measured: first 28 days after start of ventilation

  3. Length of stay

    Length of stay in the intensive care unit and in the hospital

    Measured: first 90 days after start of ventilation

  4. Mortality

    Any death during ICU- or hospital-stay, at day 28 and day 90

    Measured: first 90 days after start of ventilation

  5. Pulmonary complications

    Development of ARDS, severe hypoxemia, severe hypercapnia, severe atelectasis, pneumothorax and ventilator-associated pneumonia

    Measured: daily until ICU discharge or day 28

  6. Rescue therapies for severe hypoxemia or severe atelectasis

    Incidence of use of rescue therapies for severe hypoxemia or severe atelectasis: recruitment maneuver, prone positioning, bronchoscopy for opening atelectasis

    Measured: daily until ICU discharge or day 28

  7. Extubation failure

    Extubation with need for reintubation within 24 hours

    Measured: daily until ICU discharge or day 28

  8. Maximal inspiratory pressure (MIP)

    Maximal inspiratory pressure measured after extubation at centers that can collect this data

    Measured: within 24 hours after extubation

  9. Quality of Life questionnaire

    The European Quality of life 5 Dimensions 5 Levels questionnaire (EQ-5D-5L) is used to assess health-related quality of life status in adults. It consists of five dimensions (Mobility, Self-care, Usual activities, Pain \& discomfort, Anxiety \& depression), each of which has five severity levels (from 1 to 5) that are described by statements appropriate to that dimension. Higher values mean worse quality of life. The evaluation includes a visual analogue scale to quantitative measure the overall health status. This scale has a range from 0 to 100.

    Measured: day 28 after start of ventilation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Oct 2020
  2. Study start19 Oct 2020
  3. Primary completion16 Jul 2025
  4. Study completion16 Sep 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,201 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04593810
Sponsor's protocol ID
ACTiVE
Acronym
ACTiVE
Status last verified
Jan 2025
First submitted
11 Oct 2020
Last updated
11 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Sinnige JS, Buiteman-Kruizinga LA, Horn J, Paulus F, Schultz MJ, Serpa Neto A; ACTiVE Investigators and the Protective Ventilation Network. Effect of Automated Closed-Loop Ventilation vs Protocolized Conventional Ventilation on Ventilator-Free Days in Critically Ill Adults: A Randomized Clinical Trial. JAMA. 2026 Mar 10;335(10):874-884. doi: 10.1001/jama.2025.24384.

    PubMed 41361939
  • Botta M, Tsonas AM, Sinnige JS, De Bie AJR, Bindels AJGH, Ball L, Battaglini D, Brunetti I, Buiteman-Kruizinga LA, van der Heiden PLJ, de Jonge E, Mojoli F, Robba C, Schoe A, Paulus F, Pelosi P, Neto AS, Horn J, Schultz MJ; ACTiVE collaborative group. Effect of Automated Closed-loop ventilation versus convenTional VEntilation on duration and quality of ventilation in critically ill patients (ACTiVE) - study protocol of a randomized clinical trial. Trials. 2022 Apr 23;23(1):348. doi: 10.1186/s13063-022-06286-w.

    PubMed 35461264

Questions about this trial

What is this clinical trial studying?

A study testing INTELLiVENT-ASV and CONVENTIONAL VENTILATION in people with Ventilator-free Days and Quality of Breathing, run by Prof. Dr. Marcus J. Schultz at 10 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Netherlands, Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Ventilator-free days and alive at day 28 (time frame: first 28 days after start of ventilation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04593810, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Mar 2026.

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