Advancements in Ventilation Modes May Enhance Outcomes for Critically Ill ICU Patients

A comprehensive seven-year international, multi-center clinical trial has revealed promising benefits of a novel ventilation technique called proportional assist ventilation (PAV+). Led by researchers from the London Health Sciences Centre Research Institute (LHSCRI) and St. Michael's Hospital in Toronto, the study evaluated whether PAV+ could improve recovery parameters for patients in intensive care units (ICUs) requiring mechanical breathing support. The findings, published in the New England Journal of Medicine, suggest that although the duration of ventilation was similar between PAV+ and traditional pressure support ventilation (PSV), PAV+ demonstrated significant advantages in patient experience and safety.

During mechanical ventilation, clinicians have multiple options to support patients' breathing, with PSV being the most common. PSV delivers consistent assistance regardless of the patient’s needs. In contrast, PAV+ adapts dynamically, customizing support levels in response to each patient's efforts. Dr. Karen Bosma from LHSCRI explained that PAV+ personalizes ventilation, potentially reducing some of the risks associated with prolonged mechanical support.

The trial included 722 patients, with 573 assigned to either PAV+ or PSV. The median duration on ventilation was 7.3 days for the PAV+ group and 6.8 days for the PSV group, showing no significant difference in overall ventilation time. However, the study highlighted other important benefits: patients on PAV+ were able to emerge from sedation more quickly, and experienced fewer days with delirium—a condition linked to long-term cognitive and psychological issues. Specifically, delirium was observed on about 23% of assessment days for PAV+ patients compared to 26% in the PSV group.

Furthermore, the use of sedatives was reduced more rapidly in the PAV+ group, indicating increased comfort and potentially safer recovery trajectories. These improvements are crucial, as minimizing sedation and delirium can reduce the risk of long-term neuropsychological consequences post-ICU.

Looking ahead, the research team plans to analyze their extensive data set using artificial intelligence techniques to better understand how PAV+ influences critical health outcomes. Dr. Bosma emphasized that this large-scale study is a significant step toward optimizing mechanical ventilation strategies and enhancing patient recovery in intensive care settings.