A Randomized Trial Comparing Weaning From Mechanical Ventilation on Pressure Support vs. Proportional Assist Ventilation: A Pilot Study

Bosma, Karen J.; Read, Brooke; Nikoo, Mohammad; Bentall, Tracey; Harris, Chad; Jones, P.; Priestap, Fran; VanderHeide, Ronald

doi:10.1378/chest.1704978

Cited by 2 publications

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“…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.…”

Section: Discussionsupporting

confidence: 87%

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

et al. 2015

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BACKGROUND: Failure to wean can prolong ICU stay, increase complications associated with mechanical ventilation, and increase morbidity and mortality. The spontaneous breathing trial (SBT) is one method used to assess weaning. The aim of this study was to assess proportional assist ventilation plus (PAV؉) as an SBT by comparing its applicability, safety, and efficacy with T-tube and pressure support ventilation (PSV). METHODS: A randomized study was performed involving 160 adult subjects who remained on mechanical ventilation for > 24 h. Subjects were randomly assigned to the PAV؉, PSV, or T-tube group. When subjects were ready to perform the SBT, subjects in the PAV؉ group were ventilated in PAV؉ mode (receiving support of up to 40%), the pressure support was reduced to 7 cm H 2 O in the PSV group, and subjects in the T-tube group were connected to one T-piece with supplemental oxygen. Subjects were observed for signs of intolerance, whereupon the trial was interrupted. When the trial succeeded, the subjects were extubated and assessed until discharge. RESULTS: The subjects were predominantly male (66.5%), and the leading cause of admission was traumatic brain injury. The groups were similar with respect to baseline characteristics, and no significant difference was observed among the groups regarding extubation success or failure. Analysis of the specificity and sensitivity revealed good sensitivity for all groups; however, the PAV؉ group had higher specificity (66.6%) and higher sensitivity (97.6%), with prediction of ϳ92.1% of the success and failure events. CONCLUSIONS: No significant differences in the groups was observed regarding the rate of extubation failure, duration of mechanical ventilation, and ICU and hospital stay, indicating that PAV؉ is an alternative for use as an SBT.

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Section: Discussionsupporting

confidence: 87%

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

et al. 2015

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“…7 In addition, the authors indicate that there have been 3 previous comparisons of PAV with PSV during SBTs, all with negative results. [8][9][10] Most importantly, the patient population they chose to study was one that generally can be rapidly discontinued from ventilatory support once weaning criteria are met. About 50% of the subjects randomized were trauma victims, ϳ20% were subjects from the medical ICU, ϳ23% had a history of COPD, and only ϳ20% had a body mass index of Ͼ30%.…”

mentioning

confidence: 99%

Why Use Anything But a Standard Spontaneous Breathing Trial to Determine Readiness for Ventilator Discontinuation?

2015

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A Randomized Trial Comparing Weaning From Mechanical Ventilation on Pressure Support vs. Proportional Assist Ventilation: A Pilot Study

Cited by 2 publications

References 0 publications

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

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

Why Use Anything But a Standard Spontaneous Breathing Trial to Determine Readiness for Ventilator Discontinuation?

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