SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
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
Yifei Wang 1
Xiang Da 2
Xin Kang 3
Linlin Liu 1
Rui Zhao 1
Zi Zhu 4
Xinni Li 5
Yike Zhang 1
Conghui Wang 1
Jiehua Deng 6
1. Jining Medical University, Jining, China
2. The University of Newcastle College of Health Medicine and Wellbeing, Callaghan, Australia
3. Sun Yat-Sen University, Guangzhou, China
4. People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, Jishou, China
5. Xinyu University, Xinyu, China
6. The Second Affiliated Hospital of Guilin Medical University, Guilin, China
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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 hours 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. Keywords: Proportional Assist Ventilation plus; Pressure Support Ventilation; Mechanical Ventilation Weaning; Meta-Analysis; Critically Ill Adults
Summary
Keywords
Critically ill adults, Mechanical ventilation weaning, Meta-analysis, Pressure Support Ventilation (PSV), Proportional Assist Ventilation plus
Received
25 December 2025
Accepted
04 February 2026
Copyright
© 2026 Wang, Da, Kang, Liu, Zhao, Zhu, Li, Zhang, Wang and Deng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yifei Wang; Jiehua Deng
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