Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials

Background: Weaning from mechanical ventilation (MV) is an important step for lowering the risk of ventilator-related complications. Currently, pressure support ventilation (PSV) remains the most common weaning mode, whereas proportional assist ventilation (PAV/PAV+) has been proposed as an alternative with better weaning outcomes. We conducted this meta-analysis to compare the efficacy of PAV/PAV + and PSV in adult patients who were weaning from invasive MV. Methods: Randomized controlled trials (RCTs) comparing PAV/PAV + with PSV were identified through major databases up to September 2025. The primary outcomes were weaning success and the reintubation rate; the secondary outcomes included mortality, duration of weaning, and duration of MV. We analyzed the outcomes via RevMan 5.4, with the risk ratio (RR) and mean difference (MD) as the effect measures. Results: Seven RCTs encompassing 1,059 patients were included. The rates of weaning success were comparable between PAV/PAV + and PSV (RR 1.08; 95% CI, 1.00–1.16). PAV/PAV + was associated with a significantly lower risk of reintubation (RR 0.64; 95% CI, 0.42–0.97). There were no significant differences in mortality (RR 0.95; 95% CI, 0.72–1.25), duration of weaning (MD 5.59 hours; 95% CI, − 12.56 to 23.74), or total ventilation duration (MD − 8.21 hours; 95% CI, − 74.96 to 58.55). Conclusions: We found no significant difference between PAV/PAV + and PSV in terms of weaning success, mortality, duration of weaning, or duration of MV. PAV/PAV+, on the other hand, was linked to a decreased rate of reintubation, suggesting a potential benefit in critically ill patients. However, the presence of heterogeneity warrants cautious interpretation until further large-scale studies confirm these results.