• Marcos Delgado, Carles Subirá, Cecilia Hermosa, Federico Gordo, Jordi Riera, and Rafael Fernández.
• Department of Anesthesiology, Intensive Care Unit, Bürgerspital Solothurn, Solothurn, Switzerland - marcosdelgado1976@gmail.com.
• Minerva Anestesiol. 2019 Aug 1; 85 (8): 862-870.

BackgroundProportional assist ventilation (PAV+) is an assisted ventilator mode usually applied during weaning. We aimed to determine the feasibility of using PAV+ in the early phase of acute respiratory failure compared to volume-assist control ventilation (V-ACV) in order to shorten the length of mechanical ventilation (MV).MethodsWe conducted a prospective randomized trial comparing high-assistance PAV+ (gain 80%) vs. V-ACV in four university hospital Intensive Care Units. Patients were included based on a previous pilot trial. Length of MV was the main objective. Secondary objectives were length of stay (LOS) in ICU/hospital, and ICU/hospital/60-day mortality. Statistics - Mann-Whitney U Test and Fisher's Exact Test.ResultsWe could not find differences in length of MV or any of the analyzed variables between the 52 patients with PAV+ and 50 patients with V-ACV. The high PAV+ failure rate (42%) was attributed to excessive sedation, high respiratory rate, and high respiratory effort.ConclusionsThe use of high-assistance PAV+ in the early phase of MV does not present benefits compared to V-ACV. The high rate of PAV+ failure reinforces the need for sedative optimization, learning curve, and better patient selection.

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