Weaning from mechanical ventilation (MV) with the use of proportional assisted ventilation (PAV) or SmartCare is associated with higher rates of success compared with other methods of weaning from MV. These were among the results of a systemic review and network meta-analysis recently published in the journal Frontiers in Medicine (Lausanne).

The researchers sought to evaluate the efficacy of various ventilator-weaning procedures used in intensive care units, using systemic search to identify randomized controlled trials (RCTs) in ventilated patients, from inception through April 1, 2020.  The study included RCTs of adult patients reporting on at least 1 of the following extubation-associated outcome measures: weaning success/failure rate; percentage of patients who required reintubation; or mortality rate.

All individuals evaluated had received invasive MV for at least 24 hours due to respiratory failure of various etiologies. Trials selected for the analysis included comparisons of at least 2 modes of ventilation weaning. The most commonly used methods of ventilation included pressure support ventilation, synchronized intermittent mandatory ventilation, continuous positive airway pressure, PAV, automatic tube compensation, adaptive support ventilation, neurally adjusted ventilator assist, and SmartCare.


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A total of 39 RCTs involving 5953 patients fulfilled inclusion criteria. The most effective methods for increasing the success of weaning were SmartCare (odds ratio [OR], 2.72; 95% CI, 1.33-5.58; P =.84) and PAV (OR, 2.56; 95% CI, 1.60 to 4.11; P-score =.83). Further, PAV was superior to other modes of weaning in decreasing the percentage of patients who required reintubation (OR, 0.48; 95% CI, 0.25-0.92; P =.89) and in reducing mortality rates (OR, 0.48; 95% CI, 0.26-.92; P =.91).

The researchers concluded that additional head-to-head RCTs are warranted to examine the effects of various ventilation modes used for weaning from MV.

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.

Reference                                                                                                                                    

Jhou H-J, Chen P-H, Ou-Yang L-J, Lin C, Tang S-E, Lee C-H. Methods of weaning from mechanical ventilation in adult: a network meta-analysis. Front Med (Lausanne). Published online October 4, 2021. doi:10.3389/fmed.2021.752984