What question did this study set out to answer?

To evaluate the effectiveness of proportional assist ventilation plus compared to pressure support ventilation in facilitating successful weaning from mechanical ventilation.

February 28, 2026Open Access

Effect of proportional assist ventilation plus versus pressure support ventilation on successful weaning in critically ill adults: a systematic review, meta-analysis, and trial sequential analysis

Key Points

To evaluate the effectiveness of proportional assist ventilation plus compared to pressure support ventilation in facilitating successful weaning from mechanical ventilation.
Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs)
Searched multiple databases for studies comparing PAV+ with PSV
Included trials involving critically ill adults who underwent invasive mechanical ventilation for at least 24 hours
Analyzed outcomes related to successful weaning and associated complications
Proportional assist ventilation plus improved weaning success with a relative risk of 1.12 (95% CI: 1.02–1.23)
This significant improvement remained consistent even after sensitivity analyses
No notable differences in reintubation rates, mortality, weaning duration, or ICU length of stay were found

Abstract

Background Proportional assist ventilation plus (PAV+) and pressure support ventilation (PSV) are commonly employed ventilatory modes during the weaning process from mechanical ventilation in critically ill adult patients. Proportional assist ventilation plus delivers assistance proportional to the patient’s inspiratory effort, thereby enhancing patient–ventilator synchrony and reducing the work of breathing. However, the efficacy of proportional assist ventilation in facilitating successful weaning remains a matter of debate. Methods A comprehensive search was conducted in CENTRAL, PubMed, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov from inception to October 1, 2025 We included randomized controlled trials comparing proportional assist ventilation plus with pressure support ventilation in adult patients (≥18 years) who underwent invasive mechanical ventilation for at least 24 h prior to weaning. The primary outcome was the rate of successful weaning, while secondary outcomes included reintubation rate, ICU and hospital mortality, ICU length of stay and duration of weaning. Trial sequential analysis and subgroup analyses based on clinical intent (spontaneous breathing trial vs. continuous weaning) were integrated to enhance the robustness of the findings. Results In seven RCTs ( n = 1, 214), proportional assist ventilation plus improved weaning success (RR = 1.12, 95% CI: 1.02–1.23). Consistently, this result remained significant in sensitivity analyses excluding spontaneous breathing trial studies. No significant differences were observed in reintubation, mortality, weaning duration, or ICU length of stay. Conclusion Proportional assist ventilation plus improved weaning success compared with pressure support ventilation. This benefit remained robust in sensitivity analyses excluding spontaneous breathing trial studies. These findings suggest Proportional assist ventilation plus is a promising weaning mode, but further research is needed to optimize its implementation. Systematic review registration PROSPERO, CRD420251170692.

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