Everything has a time and place...

I work in a large tertiary care center ( Trauma/Acute Spinal/Cardiac/Neuro etc) so we get a rather large "mixed bag" of patients, my center was also one of the beta test sites back in the 90's for Puritan Bennetts initial versions of PAV+.

We are a heavily protocolized department, and have PAV+ ( via the PB 840) written into our weaning protocols/pathways. We do use it occaisonally for some of our patients where appropriate.

A neighboring hospital one health region over uses PAV+ almost exclusively in their weaning protocols, big difference in patient populations however ( they get none of the spinal, minimal neuromuscular, and have decreased acuity with subsequent deconditioning issues compared to my site.

My thoughts on PAV+ ( I have never worked with the Drager version of PAV). We have had some successes, we have had some failures. There is a definite lack of understanding from clinicians of all disciplines using the mode even after all these years, for it to be successful some thought process must be used in selecting the patients to use it with. I would use the analogy of PAV being another "tool in the toolbox", use where appropriate, if you dont know what to do with it-dont use it.

I personally have seen more successes with our use of the Maquet Servo I's NAVA than I have with PAV+ on the PB 840. NAVA has almost instantaneous response time, reacts to an actual real measured value, not an estimated extrapolated number picked up at the distal end of 6 feet vent circuit after. NAVA works well with leak, and doesnt have the risk of Vol/Flow runaway. Biggest problem with the NAVA is it's invasive. Have discovered a few extra uses for the NAVA catheter in situ while not actually in mode itself and am looking forward to getting my hands on some EIT/Pulmovista technology to investigate if EIT can be used in a similar fashion.