RCT

PROMIZING

Proportional-Assist Ventilation for Minimizing the Duration of Mechanical Ventilation

N Engl J Med, 2025 · International multicenter randomized trial (n=573 analyzed)

Clinical question

Does PAV+ shorten time to successful liberation compared with pressure-support ventilation?

Population: Mechanically ventilated adults on partial support not yet ready for liberation
Intervention: PAV+ targeting normal work of breathing
Comparator: Pressure-support ventilation
Primary outcome: Time to successful liberation from mechanical ventilation
Result: Median time to successful liberation was 7.3 days with PAV+ and 6.8 days with pressure support (P=0.58); ventilator-free days, reintubation, tracheostomy and 90-day mortality were similar.

What the trial found

PAV+ did not accelerate successful liberation compared with pressure support.

Current guideline position

Use evidence-based lung-protective ventilation and protocolized liberation; mode selection should be individualized.

Clinical interpretation

PAV+ may be used for selected physiology/interaction goals, but should not be taught as improving liberation or survival compared with protocolized pressure support.

Clinical Context & Relevant Topics (1)

Disease Reference

Invasive Mechanical Ventilation

Complete clinical topic overview. For the full 10-level interactive course, visit Master MV. Covers core ventilator modes, respiratory mechanics (Cstat, Raw, driving pressure), waveform dyssynchrony analysis, VILI prevention, and liberation protocols.

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