Airway Occlusion Pressure (P0.1) Guided Pressure Support Ventilation Versus Conventional Management in Weaning Window Patients

Mechanical ventilation is an essential modality for critically ill patients with acute respiratory failure. It supports gas exchange and reduces respiratory muscle workload, but prolonged use increases the risk of lung injury, diaphragm dysfunction, and infection. Therefore, the process of ventilator weaning is crucial in optimizing patient outcomes.

Airway occlusion pressure (P0.1), the negative pressure generated 100 ms after the onset of inspiration during an occluded breath, provides a direct measurement of patient respiratory drive independent of lung mechanics. It is a strong indicator of ventilatory demand and drive-load imbalance.

Pressure Support Ventilation (PSV) is commonly used during the weaning window, but conventional titration methods rely on clinical assessment alone. These methods do not reliably identify asynchronous events such as ineffective effort, double triggering, or premature cycling, which prolong ventilation.

Inclusion criteria

• Mechanically ventilated adult patients ≥ 21 years.
• Patients on pressure support ventilation for at least 24 hours and clinically determined to be in the weaning window (transition between assisted ventilation and spontaneous ventilation) with improving respiratory status.
• Hemodynamically stable [mean arterial pressure (MAP) ≥60 mmHg].
• All patients will be required to have light sedation with a Richmond Agitation-Sedation Scale (RASS) score between -1 and 0 to allow reliable assessment of respiratory drive.

Exclusion criteria

• Patients with neuromuscular disorders affecting respiratory drive
• Glasgow Coma Scale (GCS) score below 8
• Cervical spinal cord injury
• Receipt of neuromuscular blockers within the previous 24 hours
• Morbid obesity resulting in unreliable respiratory mechanics
• Pregnancy
• Deep sedation defined as RASS ≤ -2
• Hemodynamic instability requiring escalating vasopressor support.