Comparison of advanced closed-loop ventilation modes with pressure support ventilation for weaning from mechanical ventilation in adults: A systematic review and meta-analysis

2022 ◽  
Vol 68 ◽  
pp. 1-9
Christos F. Kampolis ◽  
Maria Mermiri ◽  
Georgios Mavrovounis ◽  
Antonia Koutsoukou ◽  
Angeliki A. Loukeri ◽  
Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Liang-Jun Ou-Yang ◽  
Po-Huang Chen ◽  
Hong-Jie Jhou ◽  
Vincent Yi-Fong Su ◽  
Cho-Hao Lee

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

Yuan Lei

‘Mechanical Ventilation Modes’ seeks to shed light on this hotly debated topic, one that is complicated by ventilator manufacturers’ non-standardized terminology. The chapter looks at conventional modes, adaptive modes, and biphasic modes, which it classifies based on the mechanical breath types in each mode. It includes a comparison chart of the terminology used for common modes on popular IPPV ventilators. Using their signature waveforms, the author describes the assist/control, SIMV, and pressure support ventilation or PSV modes. It defines the modes by their application of spontaneous breaths and mandatory breaths. It continues with a discussion of adaptive modes and biphasic modes. It ends by discussing how to select the appropriate ventilation mode.

2021 ◽  
Vol 15 (11) ◽  
pp. 2932-2933
Khayyam Farid ◽  
Imran Ul Haq ◽  
Aqsa Saleema ◽  
Ambareen Sifatullah ◽  
Fazal Wfdood ◽  

Aim: To compare pressure support versus T-piece trial for weaning from mechanical ventilation Methodology: Randomized clinical trial in Surgical ICU, Khyber Teaching hospital Peshawar. 48 patients who had been mechanically ventilated for at least 24 hours and were deemed suitable for weaning took part in the study. SBT with pressure support ventilation of 8cm of H2O was performed on one group of patients for two hours while the other group received a 30-minute SBT with pressure support ventilation. It was successful when extubation process is completed, (being able to go 72 hours without mechanical ventilation after the first SBT). Results: Extubation was successful in 83.3% who received pressure support ventilation and in 75% who employed a T-piece. The patients who required reintubation were 12% with support pressure and 16.7% with T piece ventilation. Mortality rate in support pressure group is 16.7% while 25% in T piece ventilation group. Conclusion: Pressure support ventilation for 30 minutes had a much higher success rate when it came to extubation. For spontaneous breathing trials, a shorter, less taxing ventilation approach should be used rather than the traditional one. Keywords: Extubation, Support pressure, T piece

Hérnan Aguirre-Bermeo ◽  
Jordi Mancebo

Pressure support ventilation (PSV) is one of the most common ventilatory modalities used in intensive care units. PSV is an assisted, pressure-limited, and flow-cycled ventilatory mode. The ventilator provides assistance when the patient makes a breathing effort, and when inspiratory flow reaches a certain threshold level, cycling to exhalation occurs. PSV unloads respiratory muscle effort, while allowing the patient to retain control over the respiratory rate and tidal volume. Withdrawal from mechanical ventilation should be performed with a gradual reduction of levels of support until extubation. Asynchronies can be present during PSV and are typically associated with high levels of support. A closed-loop modality, which adjusts support levels to keep the patient in a ‘comfort zone’, has been designed to assist in the withdrawal of mechanical ventilation. It performs at least as well as experienced medical staff and could be useful in specific groups of patients.

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