Proportional Assist Ventilation

The objective of this study was to compare patient-ventilator interaction during pressure-support ventilation (PSV) and proportional-assist ventilation (PAV) in the course of increased ventilatory requirement obtained by adding a dead space in 12 patients on weaning from mechanical ventilation. With PSV, the level of unloading was provided by setting the inspiratory pressure at 20 and 10 cmH2O, whereas with PAV the level of unloading was at 80 and 40% of the elastic and resistive load. Hypercapnia increased (P < 0.001) tidal swing of esophageal pressure and pressure-time product per breath at both levels of PSV and PAV. During PSV, application of dead space increased ventilation (VE) during PSV (67 +/- 4 and 145 +/- 5% during 20 and 10 cmH2O PSV, respectively, P < 0.001). This was due to a relevant increase in respiratory rate (48 +/- 4 and 103 +/- 5% during 20 and 10 cmH2O PSV, respectively, P < 0.001), whereas the increase in tidal volume (VT) played a small role (13 +/- 1 and 21 +/- 2% during 20 and 10 cmH2O PSV, respectively, P < 0.001). With PAV, the increase in VE consequent to hypercapnia (27 +/- 3 and 64 +/- 4% during 80 and 40% PAV, respectively, P < 0.001) was related to the increase in VT (32 +/- 1 and 66 +/- 2% during 80 and 40% PAV, respectively, P < 0.001), respiratory rate remaining unchanged. The increase in pressure-time product per minute and per liter consequent to acute hypercapnia and the sense of breathlessness were significantly (P < 0.001) higher during PSV than during PAV. Our data show that, after hypercapnic stimulation of the respiratory drive, the capability to increase VE through changes in VT modulated by variations in inspiratory muscle effort is preserved only during PAV; the compensatory strategy used to increase VE during PSV requires greater muscle effort and causes more pronounced patient discomfort than during PAV.

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Proportional assist ventilation feasibility in the early stage of respiratory failure: a prospective randomized multicenter trial

Minerva Anestesiologica ◽

10.23736/s0375-9393.19.12618-1 ◽

2019 ◽

Vol 85 (8) ◽

Cited By ~ 4

Author(s):

Marcos Delgado ◽

Carles Subirá ◽

Cecilia Hermosa ◽

Federico Gordo ◽

Jordi Riera ◽

...

Keyword(s):

Respiratory Failure ◽

Early Stage ◽

Multicenter Trial ◽

Proportional Assist Ventilation

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Partial Liquid Ventilation (PLV) combined with Proportional Assist Ventilation (PAV) in Spontaneously Breathing Animals: Follow-up of Gas Exchange and Survival over a Four Week Period in a Rabbit Model 1673

Pediatric Research ◽

10.1203/00006450-199804001-01695 ◽

1998 ◽

Vol 43 ◽

pp. 285-285

Author(s):

Helmut Hummler ◽

Ulrich Thome ◽

Andreas Schulze ◽

Frank Pohlandt

Keyword(s):

Gas Exchange ◽

Rabbit Model ◽

Partial Liquid Ventilation ◽

Proportional Assist Ventilation ◽

Liquid Ventilation ◽

Spontaneously Breathing

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Physiologic Response of Ventilator-dependent Patients with Chronic Obstructive Pulmonary Disease to Proportional Assist Ventilation and Continuous Positive Airway Pressure.

Cardiopulmonary Physical Therapy Journal ◽

10.1097/01823246-199910040-00008 ◽

1999 ◽

Vol 10 (4) ◽

pp. 153

Author(s):

L Appendini ◽

A Purro ◽

M Gudjonsdottir ◽

P Baderna ◽

A Patessio ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Continuous Positive Airway Pressure ◽

Pulmonary Disease ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Chronic Obstructive ◽

Proportional Assist Ventilation ◽

Obstructive Pulmonary Disease ◽

Physiologic Response

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Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation in adults: a meta-analysis and trial sequential analysis

Critical Care ◽

10.1186/s13054-020-03251-4 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Liang-Jun Ou-Yang ◽

Po-Huang Chen ◽

Hong-Jie Jhou ◽

Vincent Yi-Fong Su ◽

Cho-Hao Lee

Keyword(s):

Mechanical Ventilation ◽

Pressure Support Ventilation ◽

Sequential Analysis ◽

Pressure Support ◽

Meta Analysis ◽

Trial Sequential Analysis ◽

Proportional Assist Ventilation ◽

Support Ventilation ◽

Mechanical Ventilation Duration ◽

Significant Difference

Abstract Background 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. Whether PAV or PSV is superior for weaning remains unclear. Methods Eligible 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). Results Seven 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%). Conclusion The 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

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