Evidence map›Paper›PMID 30535648›Full record

ArticleAnnals of intensive care2018

Proportional modes versus pressure support ventilation: a systematic review and meta-analysis.

Jun Kataoka, Akira Kuriyama, Yasuhiro Norisue, Shigeki Fujitani

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of intensive care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06998927 (Proportional Assist Ventilation Plus and Estimation of Respiratory Effort in Critically Ill Patients During the Transition to Spontaneous Ventilation), which is not on this map. Cited by 15 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06998927 active not recruitingnot on this mapstarted 2024, after this paper: background citation

Proportional Assist Ventilation Plus and Estimation of Respiratory Effort in Critically Ill Patients During the Transition to Spontaneous Ventilation: A Prospective Cohort Study

TypeobservationalSponsorArgentinian Intensive Care SocietyRan2024 to 2025Enrolled35ConditionsRespiratory Effort, Proportional Assist Ventilation, Work of BreathingArmsApplication of Proportional Assist Ventilation Plus (PAV+) at three support levels (20%, 50%, 70%) to assess ventilator-displayed work of breathing and its correlation with physiologic measures.
3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Jun KataokaDepartment of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, 2790001, Japan. rdcyc910@yahoo.co.jp.ORCID http://orcid.org/0000-0002-2881-1644
Akira KuriyamaEmergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 7108602, Japan.
Yasuhiro NorisueDepartment of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, 2790001, Japan.
Shigeki FujitaniDepartment of Emergency Medicine and Critical Care Medicine, St. Marianna University, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 2168511, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProportional modes (proportional assist ventilation, PAV, and neurally adjusted ventilatory assist, NAVA) could improve patient-ventilator interaction and consequently may be efficient as a weaning mode. The purpose of this systematic review is to examine whether proportional modes improved patient-ventilator interaction and whether they had an impact on the weaning success and length of mechanical ventilation, in comparison with PSV.

methodsWe searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through May 13, 2018. We included both parallel-group and crossover randomized studies that examined the efficacy of proportional modes in comparison with PSV in mechanically ventilated adults. The primary outcomes were (1) asynchrony index (AI), (2) weaning failure, and (3) duration of mechanical ventilation.

resultsWe included 15 studies (four evaluated PAV, ten evaluated NAVA, and one evaluated both modes). Although the use of proportional modes was not associated with a reduction in AI (WMD - 1.43; 95% CI - 3.11 to 0.25; p = 0.096; PAV-one study, and NAVA-seven studies), the use of proportional modes was associated with a reduction in patients with AI > 10% (RR 0.15; 95% CI 0.04-0.58; p = 0.006; PAV-two studies, and NAVA-five studies), compared with PSV. There was a significant heterogeneity among studies for AI, especially with NAVA. Compared with PSV, use of proportional modes was associated with a reduction in weaning failure (RR 0.44; 95% CI 0.26-0.75; p = 0.003; PAV-three studies) and duration of mechanical ventilation (WMD - 1.78 days; 95% CI - 3.24 to - 0.32; p = 0.017; PAV-three studies, and NAVA-two studies). Reduced duration of mechanical ventilation was found with PAV but not with NAVA.

conclusionThe use of proportional modes was associated with a reduction in the incidence with AI > 10%, weaning failure and duration of mechanical ventilation, compared with PSV. However, reduced weaning failure and duration of mechanical ventilation were found with only PAV. Due to a significant heterogeneity among studies and an insufficient number of studies, further investigation seems warranted to better understand the impact of proportional modes. Clinical trial registration PROSPERO registration number, CRD42017059791. Registered 20 March 2017.

Indexed as

Asynchrony indexMeta-analysisNeurally adjusted ventilator assistPressure support ventilationProportional assist ventilationSystematic reviewVentilator weaning

Identifiers

PMID30535648
PMCPMC6288104

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.