Impact of Proportional Assist Ventilation Versus Pressure Support Ventilation on Adult Liberation From Mechanical Ventilation: A Revised Systematic Review and Meta-Analysis of RCTs.

BACKGROUND: Pressure assist ventilation (PAV) is considered superior to pressure support ventilation (PSV). We performed an updated systematic review and meta-analysis to evaluate comparative effectiveness in terms of weaning outcomes. METHODS: We searched PubMed, Embase, and Cochrane for eligible randomized controlled trials (RCTs) published before October 2025 that directly compared clinical outcomes of PAV and PSV in mechanically ventilated adults. R program was used to calculate risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs). RESULTS: After screening the titles, abstracts, and full texts, we included eight RCTs consisting of 1057 patients in our systematic review and meta-analysis. PAV was associated with a higher rate of weaning success as compared to PSV (RR: 1.09; 95% CI, 1.01-1.18; p = 0.03; I 2 = 23%). PAV was associated with a lesser duration of ventilation (MD: -1.06; 95% CI, -1.82 to -0.29, p = 0.006; I 2 = 0%) and intensive care unit (ICU) stay (MD: -1.49; 95% CI: -2.43 to -0.54, p = 0.002; I 2 = 25%) as compared to PSV. However, no statistically significant benefit was observed for PAV over PSV with regard to rate of reintubation (RR: 0.82; 95%, CI: 0.58-1.16, p = 0.21, I 2 = 0%) and mortality (RR: 0.89; 95% CI: 0.63-1.25 p = 0.4I 2 = 30%). CONCLUSION: PAV is superior to PSV for weaning, showing increased success and shorter duration of ventilation and ICU stays, though reintubation and mortality rates were similar.