A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV)

Abstract

PAV+ improves patient-ventilator interaction, significantly reducing the incidence of end-expiratory asynchrony and increasing the time of synchrony.

Comparison of Proportional Assist Ventilation Plus, T-Tube Ventilation, and Pressure Support Ventilation as Spontaneous Breathing Trials for Extubation: A Randomized Study

“…22 In prospective observational studies comparing PAVϩ and PSV during the weaning process regarding tolerance, duration of invasive mechanical ventilation, and clinical outcomes, no significant differences were found among the groups in mechanical ventilation duration, re-intubation rate, mortality, need for tracheostomy, and percentage of post-extubation noninvasive ventilation, indicating that PSV and PAVϩ could be considered clinically equivalent in relation to weaning. 23,24 A pilot study demonstrated the safety and feasibility of the PAVϩ algorithm for weaning, 25 confirming the findings of our study. The time that T-tube group remained in the trial was significantly shortened by 10 min, which demonstrates the staff's confidence in the T-tube; however, the testing time did not affect the incidence of extubation failure or clinical outcomes.…”

Comparative effects of proportional assist and variable pressure support ventilation on lung function and damage in experimental lung injury*

“…Higher PTP values may indicate increased activity of respiratory muscles, which likely contributed to redistribution of ventilation towards dependent regions during PAV. [8][9][10][11][12][13][14] Dependent, gravitational dependent lung regions (dorsal); nondependent, gravitational nondependent lung regions (ventral). a p < .05 vs. PSV; b p < .05 vs. noisy PSV; c p < .05 vs. dependent/nondependent region within the same group, respectively.…”

“…Accordingly, PAV may lead to increased variation in tidal volume (V T ) and respiratory rate (RR) (3), provided the patient's respiratory drive also shows increased variability. However, studies on PAV have focused on aspects of lung function and patient-ventilator asynchrony (3,(11)(12)(13), and its impact on lung damage and inflammation has not been determined.…”

Bedside Adjustment of Proportional Assist Ventilation to Target a Predefined Range of Respiratory Effort*

“…The value of the P^^^ _, p^^î could, therefore, have been underestimated in some patients. However, because tidal volume is chosen by the patient on a breath-by-breath basis (23) and the insufflation time is close to the neural inspiratory time (23,32) whatever the level of assistance (16), the risk of significant dynamic hyperinflation is low in PAV-I- (22). Eurthermore, Appendini et al ( 15) showed that adding continuous positive airway pressure during proportional assist ventilation dramatically reduced the level of PEEPi in chronic obstructive pulmonary disease (COPD) patients with a high basal level of PEEPi.…”