Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 12 ( 2016 ) > List of Articles


Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

Sunil Katyal, Nikhil Gautam, Gaganjot Kaur, Preetveen Sandhu

Keywords : Patient-ventilator dyssynchrony, pressure support ventilation, proportional assist ventilation

Citation Information : Katyal S, Gautam N, Kaur G, Sandhu P. Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study. Indian J Crit Care Med 2016; 20 (12):689-694.

DOI: 10.4103/0972-5229.195701

License: CC BY-ND 3.0

Published Online: 01-10-2017

Copyright Statement:  Copyright © 2016; The Author(s).


Background: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU) patients as a randomized crossover study. Aims: Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+) in surgical patients while weaning. Subjects and Methods: After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV) and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning. Results: Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD]) and 66.50 ± 12.47 (mean ± SD) kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+. Conclusion: Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure assistance modalities are not superior to PSV with respect to cardiorespiratory function.

PDF Share
  1. Grasso S, Puntillo F, Mascia L, Ancona G, Fiore T, Bruno F, et al. Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportional-assist ventilation. Am J Respir Crit Care Med 2000;161(3 Pt 1):819-26.
  2. Sassoon CS, Foster GT. Patient-ventilator asynchrony. Curr Opin Crit Care 2001;7:28-33.
  3. Gay PC, Hess DR, Hill NS. Noninvasive proportional assist ventilation for acute respiratory insufficiency comparison with pressure support ventilation. Am J Respir Crit Care Med 2001;164:1606-11.
  4. Varelmann D, Wrigge H, Zinserling J, Muders T, Hering R, Putensen C. Proportional assist versus pressure support ventilation in patients with acute respiratory failure: Cardiorespiratory responses to artificially increased ventilatory demand. Crit Care Med 2005;33:1968-75.
  5. Kondili E, Xirouchaki N, Vaporidi K, Klimathianaki M, Georgopoulos D. Short-term cardiorespiratory effects of proportional assist and pressure-support ventilation in patients with acute lung injury/acute respiratory distress syndrome. Anesthesiology 2006;105:703-8.
  6. Porta R, Appendini L, Vitacca M, Bianchi L, Donner CF, Poggi R, et al. Mask proportional assist vs. pressure support ventilation in patients in clinically stable condition with chronic ventilatory failure. Chest 2002;122:479-88.
  7. Bosma K, Ferreyra G, Ambrogio C, Pasero D, Mirabella L, Braghiroli A, et al. Patient-ventilator interaction and sleep in mechanically ventilated patients: Pressure support versus proportional assist ventilation. Crit Care Med 2007;35:1048-54.
  8. Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 2006;32:1515-22.
  9. Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M. Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 1997;112:1592-9.
  10. de Wit M, Miller KB, Green DA, Ostman HE, Gennings C, Epstein SK. Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med 2009;37:2740-5.
  11. Costa R, Spinazzola G, Cipriani F, Ferrone G, Festa O, Arcangeli A, et al. A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV). Intensive Care Med 2011;37:1494-500.
  12. Hart N, Hunt A, Polkey MI, Fauroux B, Lofaso F, Simonds AK. Comparison of proportional assist ventilation and pressure support ventilation in chronic respiratory failure due to neuromuscular and chest wall deformity. Thorax 2002;57:979-81.
  13. Hosking B, Nikoo M, Bosma KJ. The incidence of patient-ventilator asynchrony during weaning from mechanical ventilation: A comparison of proportional assist ventilation, (PAV) to pressure support (PS). Am J Respir Crit Care Med 2011;183:A3197.
  14. Elganady AA, Beshey BN, Abdelaziz AA. Proportional assist ventilation versus pressure support ventilation in the weaning of patients with acute exacerbation of chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc 2014;63:643-50.
  15. Xirouchaki N, Kondili E, Vaporidi K, Xirouchakis G, Klimathianaki M, Gavriilidis G, et al. Proportional assist ventilation with load-adjustable gain factors in critically ill patients: Comparison with pressure support. Intensive Care Med 2008;34:2026-34.
  16. Aguirre-Bermeo H, Bottiroli M, Italiano S, Roche-Campo F, Santos JA, Alonso M, et al. Pressure support ventilation and proportional assist ventilation during weaning from mechanical ventilation. Med Intensiva 2014;38:363-70.
  17. Teixeira SN, Osaku EF, Costa CR, Toccolini BF, Costa NL, Cândia MF, et al. Comparison of proportional assist ventilation plus, t-tube ventilation, and pressure support ventilation as spontaneous breathing trials for extubation: A randomized study. Respir Care 2015;60:1527-35.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.