Proportional modes to hasten weaning.

Purpose of review: The purpose of this review is to examine the current state of the evidence, including several recent systematic reviews and meta-analyses, to determine if proportional modes of ventilation have the potential to hasten weaning from mechanical ventilation for adult critically ill patients, compared to pressure support ventilation (PSV), the current standard of care during the recovery and weaning phases of mechanical ventilation.

Recent findings: Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) are two commercially available proportional modes that have been studied in randomized controlled trials (RCTs). Although several feasibility studies were not powered to detect differences in clinical outcomes, emerging evidence suggests that both PAV and NAVA may reduce duration of mechanical ventilation, intensive care unit (ICU) length of stay, and hospital mortality compared to PSV, as shown in some small, primarily single-centre studies. Recent meta-analyses suggest that PAV shortens duration of mechanical ventilation and improves weaning success rate, and NAVA may reduce ICU and hospital mortality.

Summary: The current state of the evidence suggests that proportional modes may hasten weaning from mechanical ventilation, but larger, multicentre RCTS are needed to confirm these preliminary findings.