Abstract
BackgroundPressure support ventilation (PSV) is the prevalent weaning method. Proportional assist ventilation (PAV) is an assisted ventilation mode, which is recently being applied to wean the patients from mechanical ventilation. Whether PAV or PSV is superior for weaning remains unclear.MethodsEligible randomized controlled trials published before April 2020 were retrieved from databases. We calculated the risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs).ResultsSeven articles, involving 634 patients, met the selection criteria. Compared to PSV, PAV was associated with a significantly higher rate of weaning success (fixed-effect RR 1.16; 95% CI 1.07–1.26; I2 = 0.0%; trial sequential analysis-adjusted CI 1.03–1.30), and the trial sequential monitoring boundary for benefit was crossed. Compared to PSV, PAV was associated with a lower proportion of patients requiring reintubation (RR 0.49; 95% CI 0.28–0.87; I2 = 0%), a shorter ICU length of stay (MD − 1.58 (days), 95% CI − 2.68 to − 0.47; I2 = 0%), and a shorter mechanical ventilation duration (MD − 40.26 (hours); 95% CI − 66.67 to − 13.84; I2 = 0%). There was no significant difference between PAV and PSV with regard to mortality (RR 0.66; 95% CI 0.42–1.06; I2 = 0%) or weaning duration (MD − 0.01 (hours); 95% CI − 1.30–1.28; I2 = 0%).ConclusionThe results of the meta-analysis suggest that PAV is superior to PSV in terms of weaning success, and the statistical power is confirmed using trial sequential analysis.Graphical abstract
Highlights
Pressure support ventilation (PSV) is the prevalent weaning method
Common methods include the Tpiece, which involves an immediate shift from full ventilator support to a period of breathing without ventilator assistance, and a program of pressure support ventilation (PSV), which gradually reduces the amount of ventilator support
The included studies evaluated 634 patients randomized to two interventions: 326 patients receiving Proportional assist ventilation (PAV) as the weaning method and 308 receiving PSV
Summary
Pressure support ventilation (PSV) is the prevalent weaning method. Proportional assist ventilation (PAV) is an assisted ventilation mode, which is recently being applied to wean the patients from mechanical ventilation. Acute respiratory failure and intubation is a common scenario in critically ill patients. The primary treatment goal is liberation from the ventilator, restoration of the patient’s ability to breathe independently and, further, removal of the endotracheal tube. The spontaneous breathing trial (SBT), which assesses the patient’s ability to breathe while receiving minimal or no ventilator support, is used to wean patients from mechanical ventilation. Common methods include the Tpiece, which involves an immediate shift from full ventilator support to a period of breathing without ventilator assistance, and a program of pressure support ventilation (PSV), which gradually reduces the amount of ventilator support. Defining suitable candidates for weaning is of critical importance in clinical practice
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