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Rationale: Liberating a patient from positive pressure ventilation to spontaneous respiration has long challenged clinicians. Emergent reintubation occurs more commonly than expected and is not without significant complications including aspiration pneumonia and even death. Proportional Assist Ventilation (PAV+) is a new ventilator modality that uses advanced computer algorithms to gauge pressure support (PS) requirements in order to improve patient-ventilator synchrony.

Objectives: To determine whether the additional information provided by PAV regarding patients ‘chest wall compliance, airways resistance, and work of breathing (WOB) may help differentiate patients that were liberated from those that were not.

Methods: We prospectively examined the respiratory mechanics of patients supported with PAV+ ventilation versus standard PS ventilation for spontaneous breathing trials (SBT).

Measurements and Main Results: Our data identified compliance and WOB as major factors predicting successful liberation. Additionally, we found significant differences in respiratory mechanics of obese patients versus non-obese patients undergoing positive pressure ventilation.

Conclusion: Additional information about respiratory mechanics revealed during SBT by PAV+ may assist in the process of liberation from mechanical ventilation.