Impact of Proportional Assist Ventilation Versus Pressure Support Ventilation on Adult Liberation From Mechanical Ventilation: A Revised Systematic Review and Meta‐Analysis of RCTs
Muhammad Hassan Raza, Obaid Ur Rehman, Umad Ali, Aqsa Komel, Pratishruti, Talha Bin Kashif, Ajay PandeyBackground
Pressure assist ventilation (PAV) is considered superior to pressure support ventilation (PSV). We performed an updated systematic review and meta‐analysis to evaluate comparative effectiveness in terms of weaning outcomes.
Methods
We searched PubMed, Embase, and Cochrane for eligible randomized controlled trials (RCTs) published before October 2025 that directly compared clinical outcomes of PAV and PSV in mechanically ventilated adults. R program was used to calculate risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs).
Results
After screening the titles, abstracts, and full texts, we included eight RCTs consisting of 1057 patients in our systematic review and meta‐analysis. PAV was associated with a higher rate of weaning success as compared to PSV (RR: 1.09; 95% CI, 1.01–1.18; p = 0.03; I 2 = 23%). PAV was associated with a lesser duration of ventilation (MD: −1.06; 95% CI, −1.82 to −0.29, p = 0.006; I 2 = 0%) and intensive care unit (ICU) stay (MD: −1.49; 95% CI: −2.43 to −0.54, p = 0.002; I 2 = 25%) as compared to PSV. However, no statistically significant benefit was observed for PAV over PSV with regard to rate of reintubation (RR: 0.82; 95%, CI: 0.58–1.16, p = 0.21, I 2 = 0%) and mortality (RR: 0.89; 95% CI: 0.63–1.25 p = 0.4 I 2 = 30%).
Conclusion
PAV is superior to PSV for weaning, showing increased success and shorter duration of ventilation and ICU stays, though reintubation and mortality rates were similar.