Synchronized mechanical ventilation for respiratory support in newborn infants

Anne Greenough; Thomas E Rossor; Adesh Sundaresan; Vadivelam Murthy; Anthony D Milner

doi:10.1002/14651858.CD000456.pub5

Sinkronizirana mehanička ventilacija za potporu disanja u novorođenčadi.

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Referencias

References to studies included in this review

Ir a:

estudios excluidos
otras versiones publicadas

Amini E, Nayeri FS, Hemati A, Esmaeilinia T, Nili F, Dalili H, et al. Comparison of High Frequency Positive Pressure Mechanical Ventilation (HFPPV) With Conventional Method in the Treatment of Neonatal Respiratory Failure. Iranian Red Crescent Medical Journal 2013;15(3):183-6. [PMID: 23983995]

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Beresford MW, Shaw NJ, Manning D. Randomised controlled trial of patient triggered and conventional fast rate ventilation in neonatal respiratory distress syndrome. Archives of Disease in Childhood 2000;82(1):F14-18.

Bernstein G, Mannino FL, Heldt GP, Callahan JD, Bull DH, Sola A, et al. Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates. Journal of Pediatrics 1996;128(4):453-63.

Chan V, Greenough A. Randomised controlled trial of weaning by patient triggered ventilation or conventional ventilation. European Journal of Pediatrics 1993;152(1):51-4.

Chan V, Greenough A. Comparison of weaning by patient triggered ventilation or synchronous mandatory intermittent ventilation. Acta Paediatrica 1994;83(3):335-7.

Chen J-Y, Ling U-P, Chen J-H. Comparison of synchronized and conventional intermittent mandatory ventilation in neonates. Acta Paediatrica Japonica 1997;39(5):578-83.

Courtney SE, Durand DJ, Asselin JM, Hudak ML, Aschner JL, Shoemaker CT. High-Frequency Oscillatory ventilation versus conventional mechanical ventilation for very-low birth-weight infants. New England Journal of Medicine 2002;347(9):643-52. [PMID: 12200551]

Craft AP, Bhandari V, Finer NN. The sy-fi study: a randomized prospective trial of synchronized intermittent mandatory ventilation versus a high-frequency flow interrupter in infants less than 1000 g. Journal of Perinatology 2003;23(1):14-9. [PMID: 12556921]

D'Angio CT, Chess PR, Kovacs SJ, Sinkin RA, Phelps DL, Kendig JW, et al. Pressure-regulated volume control ventilation vs synchronized intermittent mandatory ventilation for very low birthweight infants. Archives of Pediatric and Adolescent Medicine 2005;159(9):868-75.

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Erdemir A, Kahramaner Z, Turkoglu E, Cosar H, Sutcuoglu S, Ozer EA. Effects of synchronized intermittent mandatory ventilation versus pressure support plus volume guarantee ventilation in the weaning phase of preterm infants*. Pediatric Critical Care Medicine 2014;15(3):236-41. [PMID: 24608494]

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References to studies excluded from this review

Ir a:

estudios incluidos
otras versiones publicadas

Abd El-Moneim ES, Fuerste HO, Krueger M, Elmagd AA, Brandis M, Schulte-Moenting J, et al. Pressure support ventilation combined with volume guarantee versus synchronized intermittent mandatory ventilation: a pilot crossover trial in premature infants in their weaning phase. Critical Care Medicine 2005;6(3):286-92.

Abubakar K, Keszler M. Effect of volume guarantee combined with assist/control vs synchronized intermittent mandatory ventilation. Journal of Perinatology 2005;25(10):638-42.

Amitay M, Etches PC, Finer NN, Maidens JM. Synchronous mechanical ventilation of the neonate with respiratory disease. Critical Care Medicine 1993;21(1):118-24.

Bernstein G, Cleary JP, Heldt GP, Rosas JF, Schellenberg l, Mannino FL. Response time and reliability of three neonatal patient triggered ventilators. American Review of Respiratory Disease 1993;148(2):358-64.

Bitondo M M, Aguirre-Bermeo H M, Moccaldo A, De Santis P, Bernini V, Tersali A, et al. Patient-ventilator asynchrony during conventional or automated pressure support ventilation in difficult-to-wean patients. Critical Care 2012;16(Suppl 1):P126. [DOI: 10.1186/cc10733]

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de Boer RC, Jones A, Ward PS, Baumer JH. Long term trigger ventilation in neonatal respiratory distress syndrome. Archives of Disease in Childhood 1993;68:308-11.

de la Oliva P, Schuffelmann C, Gomez-Zamora A, Villar J, Kacmarek R M. Asynchrony, neural drive, ventilatory variability and COMFORT: NAVA versus pressure support in pediatric patients. A non-randomized cross-over trial. Intensive Care Med 2012;38(5):838-46. [PMID: 22481227]

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Dimitriou G, Greenough A, Lauscher B, Yamaguchi N. Comparison of airway pressure triggered and airflow triggered ventilation in immature infants. Acta Paediatrica 1998;87(12):1256-60.

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Durand DJ, Asselin JM, Hudak ML, Aschner JL, McArtor RD, Cleary JP, et al. Early high-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in very low birth weight infants: a pilot study of two ventilation protocols. Journal of Perinatology 2001;21(4):221-9.

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Greenough A, Morley CJ, Pool J. Fighting the ventilator - are fast rates an effective alternative to paralysis? Early Human Development 1986;13(2):189-94.

Greenough A, Pool J, Greenall F, Morley CJ, Gamsu H. Comparison of different rates of artificial ventilation in preterm neonates with the respiratory distress syndrome. Acta Paediatrica Scandinavica 1987;76(5):706-12.

Greenough A, Greenall F, Gamsu H. Synchronous respiration - which ventilator rate is best? Acta Paediatrica Scandinavica 1987;76(5):713-18.

Greenough A, Greenall F. Patient triggered ventilation in premature neonates. Archives of Disease in Childhood 1988;63:77-8.

Greenough A, Pool J. Neonatal patient triggered ventilation. Archives of Disease in Childhood 1988;63:394-7.

Greenough A, Hird MF, Chan V. Airway pressure triggered ventilation for preterm neonates. Journal of Perinatal Medicine 1991;19(6):471-6.

Gupta S, Sinha SK, Donn SM. The effect of two levels of pressure support ventilation on tidal volume delivery and minute ventilation in preterm infants. Archives of Disease in Childhood. Fetal and Neonatal Edition 2009;94(2):F80-3. [PMID: 18676412]

Guthrie SO, Lynn C, Lafleur BJ, Donn SM, Walsh WF. A crossover analysis of mandatory minute ventilation compared to synchronized intermittent mandatory ventilation in neonates. Journal of Perinatology 2005;25(10):643-6.

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Herrera CM, Gerhardt T, Claure N, Everett R, Musante G, Thomas C, et al. Effects of volume-guaranteed synchronized intermittent mandatory ventilation in preterm infants recovering from respiratory failure. Pediatrics 2002;110(3):529-33.

Hird MF, Greenough A. Causes of failure of neonatal patient triggered ventilation. Early Human Development 1990;23(2):101-8.

Hird MF, Greenough A. Gestational age: an important influence on the success of patient triggered ventilation. Clinical Physics and Physiological Measurement 1990;11(4):307-12.

Hird MF, Greenough A. Randomised trial of patient triggered ventilation versus high frequency positive pressure ventilation in acute respiratory distress. Journal of Perinatal Medicine 1991;19(5):379-84 (listed in Wallach EE (ed) Current Opinion in Obstetrics & Gynecology, February 1993).

Hird MF, Greenough A. Patient triggered ventilation in chronically ventilator-dependent infants. European Journal of Pediatrics 1991;150(10):732-4.

Hird MF, Greenough A. Patient triggered ventilation using a flow triggered system. Archives of Disease in Childhood 1991;66(10 Spec No):1140-3.

Hird MF, Greenough A. Comparison of triggering systems for neonatal patient triggered ventilation. Archives of Disease in Childhood 1991;66(4 Spec No):426-8 (abstracted in Clinical Digest Series - Pediatrics/Neonatology, Northbrook IL, USA).

Hummler H, Gerhardt T, Gonzalez A, Claure N, Everett R, Bancalari E. Influence of different methods of synchronized mechanical ventilation on ventilation, gas exchange, patient effort and blood pressure fluctuations in premature neonates. Pediatric Pulmonology 1996;22(5):305-13.

Hummler H, Gerhardt T, Gonzalez A, Claure N, Everett R, Bancalari E. Increased incidence of sighs (augmented inspiratory eforts) during synchronized intermittent mandatory ventilation (SIMV) in preterm neonates. Pediatric Pulmonology 1997;24(3):195-203.

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Jarreau P-H, Moriette G, Mussat P, Mariette C, Mohanna A, Harf A, et al. Patient-triggered ventilation decreases the work of breathing in neonates. American Journal of Respiratory and Critical Care Medicine 1996;153(3):1176-81.

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Kapasi M, Fujino Y, Kirmse M, Catlin EA, Kacmarek RM. Effort and work of breathing in neonates during assisted patient triggered ventilation. Pediatric Critical Care Medicine 2001;2:9-16.

Keszler M, Abubakar K. Volume guarantee: stability of tidal volume and incidence of hypocarbia. Pediatric Pulmonology 2004;38(3):240-5.

Laubscher B Greenough A, Kavadia V. Comparison of body surface and airway triggered ventilation in extremely premature infants. Acta Paediatrica 1997;86(1):102-4.

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McCallion N, Lau R, Morley CJ, Dargaville PA. Neonatal volume guarantee ventilation: effects of spontaneous breathing, triggered and untriggered inflations. Archives of Disease in Childhood. Fetal and Neonatal Edition 2008;93(1):F36-9. [PMID: 17686798]

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Mitchell A, Greenough A, Hird MF. Limitations of neonatal patient triggered ventilation. Archives of Disease in Childhood 1989;64:924-9.

Mizuno K, Takeuchi T, Itabashi K, Okuyama K. Efficacy of synchronized IMV on weaning neonates from the ventilator. Acta Paediatrica Japonica 1994;36(2):162-6.

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References to other published versions of this review

Ir a:

estudios incluidos
estudios excluidos

Greenough A, Milner AD, Dimitriou G. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews 1998, Issue 1. [DOI: 10.1002/14651858.CD000456]

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Greenough A, Milner AD, Dimitriou G. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD000456]

Greenough A, Milner AD, Dimitriou G. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD000456.pub2]

Greenough A, Dimitriou G, Prendergast M, Milner AD. Synchronized mechanical ventilation for respiratory supporting newborn infants. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD000456.pub3]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

Amini 2013

*Study characteristics*
Methods	Randomised Single centre trial Randomisation method: block randomisation Blinding of randomisation: unclear Blinding of intervention: no Blinding of outcome measurement: no Complete follow‐up: yes
Participants	All neonates admitted to NICU with respiratory failure requiring mechanical ventilation (respiratory failure and gestational age not defined). All infants received surfactant. Exclusion criteria include: complex congenital heart disease, genetic syndromes, major anomalies, hypoxic ischaemic encephalopathy or birth asphyxia. HFPPV 31; CMV 31
Interventions	HFPPV or CMV
Outcomes	No primary outcome stated. Outcomes reported were IVH, air leak, mortality, treatment failure, duration of mechanical ventilation, number of doses of surfactant administered, oxygen requirement at 28 days, PVL
Notes	Ventilator types: Bearcub 750 used for both interventions
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Block randomisation"; no further details given
Allocation concealment (selection bias)	Low risk	"Block randomisation"; no further details given.
Blinding (performance bias and detection bias) All outcomes	High risk	Clinician aware of intervention
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding possible
Blinding of outcome assessment (detection bias) All outcomes	High risk	Clinicians likely to be aware of intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Complete follow‐up of recruited infants

Baumer 2000

*Study characteristics*
Methods	Randomised Multicentre trial Randomissation method: randomly allocated by telephone Stratified by centre. Within each centre, randomisation in blocks to ensure a similar distribution of babies in each arm of the study Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	Gestational age < 32 weeks. Assisted ventilation within 72 hours of birth Not ventilated for more than 6 hours at randomisation RDS Exclusion: major congenital malformation or inhalational pneumonitis Sample size: 924 PTV: 465 CMV: 459
Interventions	PTV vs CMV
Outcomes	Primary: Hospital mortality or need for oxygen treatment at 36 weeks of gestation; pneumothorax cerebral ultrasound abnormality nearest to 36 weeks of gestation; duration of ventilation in survivors
Notes	Ventilator types: PTV: SLE 2000 (airway pressure trigger) Draeger baby log 8000 (airway flow trigger) CMV: SLE 2000, Draeger Babylog, Sechrist 423 of those randomised to PTV and 422 infants randomised to CMV had cranial ultrasound examination
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Randomly allocated by telephone"
Allocation concealment (selection bias)	Low risk	"Within each centre, randomisation was performed in blocks" Probably done
Blinding (performance bias and detection bias) All outcomes	High risk	"Form of ventilation to which they were assigned from birth to final extubation" Comment: no blinding
Blinding of participants and personnel (performance bias) All outcomes	High risk	"Clinicians were allowed the discretion to change the baby from the assigned mode of ventilation" Comment: no blinding as clinicians aware of the intervention
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: clinicians likely to be aware of the intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcome for death (912/924); pneumothorax(922/924); cranial USS (848/924)

Beresford 2000

*Study characteristics*
Methods	Randomised Multicentre trial Randomisation method: computer generated sequence hidden in sequentially numbered, opaque envelopes Stratified by BW Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	Birth weight 1000 to 2000 grams Assisted ventilation within 24 hours of birth RDS Exclusion: major malformations, congenital heart disease, MAS Sample size: 386 PTV: 193 CMV: 193
Interventions	PTV vs CMV
Outcomes	Primary: Incidence of CLD Secondary: Death Pneumothorax IVH Cystic PVL Shunt insertion
Notes	Ventilator types: SLE 2000 (airway pressure trigger)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Computer generated sequence".
Allocation concealment (selection bias)	Low risk	"Hidden in sequentially numbered, sealed, opaque envelopes".
Blinding (performance bias and detection bias) All outcomes	High risk	"Study design was such as to preclude crossover of treatment strategy". Comment: clinician aware of the mode of intervention
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: clinicians aware of the intervention
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: clinicians aware of the intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: complete data present

Bernstein 1996

*Study characteristics*
Methods	Randomised Multicenter trial Intention‐to‐treat basis Randomisation method: sealed, opaque envelopes. Stratified by BW Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	BW > 500 grams Assisted ventilation Age < 36 hours RDS, congenital pneumonia, MAS CxR with abnormal lung parenchyma, FiO₂ > 0.4 (all BW) and MAP > 7 cmH₂O (for infants with BW > 1250 grams). Duration of CMV prior randomisation < 12 hours, spontaneous breathing rate > 20 bmp and indwelling arterial line Exclusion: infants with air leak, seizures, IVH grade III or IV, neuromuscular disease affecting respiration, major malformations including chromosomal abnormalities, CDH, CHD (except PDA), lung hypoplasia, septic shock or severe skin disease Sample size: 350* SIMV: 178 (167 analysed) CMV: 172 (160 analysed) *23 excluded post randomisation
Interventions	SIMV vs CMV
Outcomes	Primary: Acute effect on oxygenation Sedative/analgesic drug requirements Duration of ventilation Air leaks Secondary: Severe IVH Death Need for pharmacological paralysis ECMO or long‐term supplemental oxygen The age at which infants undergoing long‐term ventilation (> 14 days) regained their BW
Notes	Ventilator types: Infant Star with Star Sync module (abdominal movement monitor)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Randomisation schedules were generated for each centre by computer"
Allocation concealment (selection bias)	Low risk	"Sequenfial, opaque, sealed envelopes"
Blinding (performance bias and detection bias) All outcomes	Low risk	"Intention‐to‐treat protocol"
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: clinicians aware of intervention (intention‐to‐treat protocol)
Blinding of outcome assessment (detection bias) All outcomes	High risk	"Data were collected prospectively" Comment: clinicians probably aware of intervention (intention‐to‐treat protocol)
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcome for all participants reported

Chan 1993

*Study characteristics*
Methods	Randomised Single centre trial Randomisation method: sealed, opaque envelopes Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	Gestational age < 36 weeks. Age: 1 to 21 days. RDS. In the recovery stage of the respiratory disease (at 40 bpm) Sample size: 40 PTV: 20 CMV: 20
Interventions	PTV vs CMV
Outcomes	Primary: Hours of ventilation from entering the study until first extubation (weaning) Secondary: Number of infants who failed weaning Number of infants who failed extubation
Notes	Ventilator types: SLE 2000 (airway pressure trigger), Sechrist IV‐100B
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Sealed, opaque envelopes"
Allocation concealment (selection bias)	Low risk	Not revealed to clinician
Blinding (performance bias and detection bias) All outcomes	Low risk	Quote: "protocol for weaning from ventilation was similar in both groups" Comment: clinicians not blinded to the method of weaning.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote:"not possible to "blind" the clinicians" Comment: different ventilators used for the two study groups
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: clinicians aware of intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcome for all participants reported

Chan 1994

*Study characteristics*
Methods	Randomised Single centre trial Randomisation method: sealed, opaque envelopes Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	GA < 35 weeks Age < 1 to 23 days Weaning – loaded with aminophylline Exclusion: apnoea, failure to trigger Sample size: 40 SIMV: 20 CMV: 20
Interventions	PTV vs SIMV
Outcomes	Primary: Duration of weaning Secondary: Number of infants who failed weaning Number of infants who failed extubation
Notes	Ventilator types: SLE 2000 (airway pressure trigger) CMV
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Randomised" By sealed opaque envelope
Allocation concealment (selection bias)	Low risk	"Consecutively drawing cards from sealed envelope" Comment: clinicians blinded to allocation
Blinding (performance bias and detection bias) All outcomes	Low risk	"protocol for weaning from ventilation was similar in both groups" Comment: clinicians aware of intervention
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: clinicians aware of the intervention
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: clinicians aware of intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcome for all participants reported

Chen 1997

*Study characteristics*
Methods	Randomised Single centre trial Blinding of randomisation: not stated Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	BW < 1.75 kg, GA < 34 weeks and RDS Assisted ventilation Exclusion: congenital malformation, inherited metabolic abnormalities, sepsis, treatment with muscle relaxants Sample size: 77 SIMV: 38 CMV: 39 RDS sample size: 62 SIMV: 31 CMV: 31 MAS sample size: 15 SIMV: 7 CMV: 8 Term infants (MAS) excluded from the analysis
Interventions	SIMV vs CMV
Outcomes	Primary: Duration of ventilation Need of reintubation Air leaks PDA IVH Secondary: BPD ROP Death
Notes	Ventilator types: Infant Star with Star sync module (airflow trigger) (CMV) Bear Cub
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Randomised"
Allocation concealment (selection bias)	Unclear risk	Comment: the evaluator was unaware of the treatment status of the patients
Blinding (performance bias and detection bias) All outcomes	High risk	Comment: not possible to assess
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: not possible to assess
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: not possible to assess
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcome for all participants reported

Courtney 2002a

*Study characteristics*
Methods	Randomised controlled multicentre study randomised by off‐site clinical coordination centre
Participants	BW 601 to 1200 grams appropriately developed for gestational age < 4 hours of age and expected to require ventilation for at least 24 hours Exclusion: if Apgar at 5 minutes < 4; a base deficit of 15 or more prior to study; severe hypotension; chromosomal or genetic abnormalities; congenital heart disease or known neuromuscular disease
Interventions	HFO with Sensormedics 3100a or SIMV with either VIP Bird, Babylog 8000, Bear Cub with neonatal monitoring or Bear Cub 750vs
Outcomes	Primary outcome: death or BPD (oxygen requirement at 36 weeks) successful extubation IVH, PVL, pneumothorax, PIE, pulmonary haemorrhage, bacteraemia, PDA, NEC, ROP
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomised by off‐site clinical coordination centre. Probably done
Allocation concealment (selection bias)	Low risk	Off‐site allocation
Blinding (performance bias and detection bias) All outcomes	High risk	No blinding of clinicians: different ventilators used for different arms
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding possible as above
Blinding of outcome assessment (detection bias) All outcomes	High risk	Clinicians likely to be aware of intervention
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	10 infants from HFOV and 4 from SIMV withdrawn – data analysed until point of withdrawal

Craft 2003a

*Study characteristics*
Methods	Multicentre randomised controlled trial Randomised using random number sequence with assignments in opaque sealed envelopes Block randomisation (units of 10) crossover to alternative method in event of failure – analysis by intention to treat
Participants	23 to 34 weeks gestation weighing < 1000 grams requiring mechanical ventilation No exclusion criteria stated Grouped 500 to 750 g and 750 to 1000 grams – data combined for meta‐analysis
Interventions	SIMV or high‐frequency flow interruption (HFFI)
Outcomes	Days of mechanical ventilation Days of CPAP days of oxygen requirement BPD (Oxygen requirement at 36 weeks) Airleak PDA Grade 3 or 4 IVH Grade 3 or 4 ROP Death
Notes	Infant Star ventilator. Graseby capsule used for synchronisation. Extubation when rate reduced to 8 to 12 bpm.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Infants were randomly assigned by a sealed opaque envelope, with a previously generated random number sequence"
Allocation concealment (selection bias)	Low risk	Clinicians blinded to allocation
Blinding (performance bias and detection bias) All outcomes	High risk	Not possible to blind clinician to treatment arm
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not possible to blind clinician to treatment arm
Blinding of outcome assessment (detection bias) All outcomes	High risk	Assessors likely aware of treatment arm
Incomplete outcome data (attrition bias) All outcomes	High risk	Attrition unclear. Study terminated at ad‐hoc interim analysis

D'Angio 2005

*Study characteristics*
Methods	Randomised Single centre trial Randomisation method: block randomisation scheme by one of the investigators Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	Ventilated infants BW of 500 to 1249 grams Less than six hours of age Gestational age > 24 weeks Sample size: 212 PRVCV: 104 SIMV: 108
Interventions	PRVCV vs SIMV
Outcomes	Primary: proportion of infants alive and extubated at 14 days Secondary: death Moderate/severe BPD Air leaks Severe IVH (grades 3 and 4)
Notes	Ventilator type: Servo 300, infants who required slow rates > 40 bpm (maximum for the Servo 300) were transferred to the BIRD VIP ventilator
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	Quote: "randomly assigned " Comment: probably done
Blinding (performance bias and detection bias) All outcomes	Low risk	Comment: probably done (Failure and Weaning protocol followed)
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: clinicians likely to be aware of the intervention
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: clinicians likely to be aware of the intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: respiratory outcomes for all participants reported

Dimitriou 1995a

*Study characteristics*
Methods	Randomised Single centre trial Randomisation method: sealed, opaque envelopes Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	GA < 35 weeks Age < 15 days Weaning – loaded with aminophylline Exclusion: apnoea, failure to trigger Sample size: 40 PTV: 20 SIMV: 20
Interventions	PTV vs SIMV
Outcomes	Primary: Duration of weaning Secondary: Number of infants who failed weaning Number of infants who failed extubation
Notes	Ventilator types: SLE 2000 (airway pressure trigger)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Random selection"
Allocation concealment (selection bias)	Low risk	"Drawing a card"
Blinding (performance bias and detection bias) All outcomes	Low risk	Done as protocol followed
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: clinicians likely to be aware of the intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcome of all trial participants reported.

Dimitriou 1995b

*Study characteristics*
Methods	Randomised. Single centre trial Randomisation method: sealed, opaque envelopes Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	GA < 35 weeks Age < 15 days Weaning – loaded with aminophylline Exclusion: apnoea, failure to trigger Sample size: 40 PTV: 20 SIMV: 20
Interventions	PTV vs SIMV
Outcomes	Primary: Duration of weaning Secondary: Number of infants who failed weaning Number of infants who failed extubation
Notes	Ventilator types: SLE 2000 (airway pressure trigger)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Random selection"
Allocation concealment (selection bias)	Low risk	"Drawing a card"
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Done as protocol followed
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: clinicians likely to be aware of the intervention
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: outcome of all trial participants reported.

Donn 1994

*Study characteristics*
Methods	Randomised Single centre trial Randomisation method: lottery (sampling without replacement) Blinding of randomisation: not reported Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	Preterm infants. BW between 1.1 to 1.5 kg RDS, SRT Sample size: 30 PTV: 15 CMV: 15
Interventions	PTV vs CMV
Outcomes	Primary: Duration of ventilation Secondary: Air leaks IVH CLD
Notes	Ventilator types: PTV V.I.P. BIRD (airflow trigger) CMV Sechrist IV‐100B, V.I.P. BIRD
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Randomised"
Allocation concealment (selection bias)	Low risk	"lottery (sampling without replacement)"
Blinding (performance bias and detection bias) All outcomes	High risk	Comment: not reported
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: not possible to assess
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcome of all trial participants reported

Erdemir 2014

*Study characteristics*
Methods	Randomised Single centre trial Sealed envelope randomisation
Participants	60 prematurely born infants 30 SIMV 30 gestation < 33 weeks or birth weight < 1500 grams requiring mechanical ventilation for RDS Exclusion criteria: admission after 6 hours of age congenital cardiac, respiratory or CNS malformation congenital metabolic disease congenital pneumonia or sepsis perinatal asphyxia leak around ET tube of < 20%
Interventions	Received surfactant placed on PTV, then randomised to SIMV or PSV + VG when FiO₂ < 0.4, RR < 60, PIP 16 cmH₂O, PEEP 4 cmH₂O with adequate blood gases
Outcomes	Duration of weaning time to extubation PIP, MAP, Vt, RR at start, during and at end of weaning
Notes	58 recruited, 45 reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Sealed envelope randomisation": sequence generation unclear
Allocation concealment (selection bias)	Low risk	"Sealed envelope randomisation"
Blinding (performance bias and detection bias) All outcomes	High risk	No blinding
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	All outcomes reported for all participants

Heicher 1981

*Study characteristics*
Methods	Quasi‐randomised Single centre trial Patients alternatively assigned to one of the two study ventilatory modes Blinding of randomisation: no Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	Birth weight > 750 grams. No gross anomalies. Abnormal lung fields on chest radiograph. Respiratory distress syndrome, pneumonia Exclusion: infants with chromosomal abnormalities or meconium aspiration Sample size: 102 Rapid rates: 51 Slow rates: 51
Interventions	HFPPV. Rapid rates (60 bpm) with IT: 0.5 sec versus slow rates (20 to 40 bpm) with IT: 1sec
Outcomes	Clinical improvement Need for pharmacological paralysis Hours of assisted ventilation Hours of FiO₂ > 0.6. CLD Mortality
Notes	Ventilator types: Baby Bird, Bird Co
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Quote: "were alternately assigned" Comment: not randomised
Allocation concealment (selection bias)	High risk	Comment: assigned not randomised
Blinding (performance bias and detection bias) All outcomes	Low risk	Quote:"remained constant throughout the study period" Comment: probably done
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: probably not done
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcomes reported for all trial participants

Liu 2011

*Study characteristics*
Methods	Randomised trial Single centre Randomisation method: random number table Blinding of randomisation: unclear Blinding of intervention: no Complete follow‐up: yes Blinding of outcome measurement: not clear
Participants	GA < 35 weeks Mechanical ventilation RDS Age < 12 hours old Arterial blood gas pH < 7.25; PaO₂ < 50mmHg; PaCO₂ > 50 mmHg PaO₂/FiO₂ ≤ 250 mmHg; a/APO₂ ≤ 0.22 Exclusion criteria: congenital lung abnormalities, pulmonary haemorrhage, pneumothorax, congenital pneumonia, meconium aspiration, wet lung, complex congenital heart disease, grade 3/4 intracranial haemorrhage Sample size: 84 SIPPV + VG: 31 CMV: 30 HFOV: 23
Interventions	SIPPV +VG vs CMV vs HFOV
Outcomes	Primary: Duration of mechanical ventilation Oxygenation status Secondary: Death Air leak Ventilation associated pneumonia Intraventricular haemorrhage (Grade 3/4)
Notes	Ventilator types: Babylog 8000 plus, Sensormedics 3100 A
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Comment: random number table used
Allocation concealment (selection bias)	High risk	Comment: probably not used
Blinding (performance bias and detection bias) All outcomes	High risk	Comment: probably not done
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: probably not done
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: probably not done
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcomes of all participants reported.

OCTAVE 1991

*Study characteristics*
Methods	Randomised Multicentre trial Randomisation method: sealed, opaque envelopes Blinding of randomisation: yes Blinding of intervention: no Complete follow‐up: yes Blinding of outcome measurement: no
Participants	Age < 72 hours. Assisted ventilation Exclusion: meconium aspiration Sample size: 346 HFPPV: 174 CMV: 172
Interventions	HFPPV (60 bpm) versus CMV (20 to 40 bpm)
Outcomes	Incidence of pneumothorax Incidence and severity of CLD Mortality Neurodevelopmental outcome
Notes	Ventilator type: Sechrist IV 100B
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "random assignment" Comment: probably done
Allocation concealment (selection bias)	Low risk	Quote: "sealed,opaque, serially numbered envelope" Comment: probably done
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: clinicians probably aware of the intervention
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: clinicians probably aware of the intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: short‐term outcome reported for all participants

Patel 2012

*Study characteristics*
Methods	Randomised Single centre study Randomisation: sequential opaque sealed envelopes with contents generated by random number table Randomised at initiation of weaning ventilation
Participants	Ventilated, less than 14 days old excluding: congenital heart disease or HIE Evaluation of weaning: randomised when FiO₂ < 0.4; PIP ≤ 20 cmH₂O if ≥ 29 weeks' gestation; ≤ 17 cmH₂O if between 26 and 29 weeks' gestation; or ≤ 15 cmH₂O if ≤ 26 weeks' gestation 18 ACV, 18 PSV
Interventions	ACV Vs PSV (backup 40 bpm, trigger 0.6 to 1.0 litre/min)
Outcomes	Duration of weaning, time to extubation
Notes	All infants ventilated with SLE5000 Data in paper expressed as median and range
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Patients were randomised using a sequential opaque sealed envelope system, the contents having been determined by random number table generation": low risk
Allocation concealment (selection bias)	Low risk	As above; block allocation with six in each block
Blinding (performance bias and detection bias) All outcomes	Low risk	No blinding of clinician. Analysis by intention to treat
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	Not all short term outcomes measured at all time points, but relevant outcomes reported for all participants

Pohlandt 1992

*Study characteristics*
Methods	Randomised (with stratification for gestational age) Method of randomisation: random number table. Blinding of randomisation: not reported Blinding of intervention: no Complete follow‐up: no Blinding of outcome measurement: no
Participants	Gestational age < 32 weeks Assisted ventilation Supplemental FiO₂ > 0.4 Sample size: 181 HFPPV: 91 CMV: 90
Interventions	HFPPV (60 bpm with IT: 0.3 sec) vs CMV (30 to 40 bpm with IT: 1 sec)
Outcomes	Incidence of extra‐alveolar air leaks Mortality
Notes	Ventilator types: AIV Loosco MKII, Biomed MVP 10, Babylog‐Draeger, Sechrist IV‐100B, Siemens Servo‐B and Servo‐C, Stephan 181 infants were enrolled into the study, but only 137 fulfilled the criteria and their results were analysed
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Quote: "random number table" Comment: probably not followed
Allocation concealment (selection bias)	High risk	Comment: probably not done
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: clinicians probably aware of the intervention
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: probably not done
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: primary outcomes of all participants reported

Reyes 2006

*Study characteristics*
Methods	Randomised Single centre Randomisation method: sequential Sealed opaque envelopes from a computer‐generated randomised list Blinding of randomisation: no Complete follow‐up: yes Blinding of outcome measurement: no
Participants	Birth weight 500 to 1000 grams appropriate birth weight for gestational age Mechanical ventilation requirement < 12 hours after birth until 7 days Exclusion: congenital anomalies; neuromuscular disease; lung hypoplasia; congenital heart disease; hypotension requiring intravenous medication; PIE or pneumothorax; required HFOV > 24 hours; received sedation or muscle relaxation Sample size: 107 53: SIMV plus PS 54: SIMV
Interventions	SIMV plus PS versus SIMV
Outcomes	Primary: Proportion of infants requiring supplementary oxygen at 28 days Secondary: Death Air leaks BPD IVH (Grades III and IV) (Grade III and IVH)
Notes	Ventilator type: Pressure‐limited flow triggered VIP ventilator
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Block randomisation" Comment: probably done
Allocation concealment (selection bias)	High risk	Comment: probably not followed
Blinding (performance bias and detection bias) All outcomes	Low risk	Quote: "study protocol was actively followed" Comment: probably done
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote: "Caregivers were not blinded to the assigned modality" Comment: not followed
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: clinicians probably aware of the intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: outcomes of all trial participants reported

Singh 2012

*Study characteristics*
Methods	Randomised controlled single centre study Randomisation: web‐based random number generator generated allocation sequence, which was placed in sequential sealed opaque envelopes
Participants	preterm neonates requiring mechanical ventilation excluding: BW < 750 grams; major congenital anomaly; perinatal asphyxia; shock; prior air leak If did not undergo 24 hours of ventilation the patient was excluded from analysis 66 HFO, 84 SIMV
Interventions	SIMV or HFOV
Outcomes	FiO₂, MAP, OI at 1, 6 and 24 hours Duration of ventilation Oxygen dependency at 28 days Hospital stay Survival IVH, PVL, PDA, ROP, pulmonary haemorrhage, ventilator associated pneumonia
Notes	SIMV delivered with SLE2000, HFOV with Draeger Babylog 8000
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Simple randomisation using a web‐based random number generator ": probably done
Allocation concealment (selection bias)	Low risk	"slip of paper bearing the intervention was kept in serially numbered opaque sealed envelopes": probably done
Blinding (performance bias and detection bias) All outcomes	High risk	No blinding
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding
Incomplete outcome data (attrition bias) All outcomes	High risk	HFOV arm 17 died/left study; SIMV 23 died/left study

Sun 2014

*Study characteristics*
Methods	Randomised single centre study computer‐generated randomisation after consent stratified by sex and gestational age
Participants	admitted to NICU with gestational age < 32 weeks; birth weight < 1500 grams; requiring mechanical ventilation for respiratory distress syndrome with PaO₂/FiO₂ < 200 mmHg exclusion: genetic metabolic diseases; congenital abnormalities; pneumothorax or grade III or IV IVH prior to randomisation randomised: 336 — 184 to SIMV, 182 to HFOV
Interventions	SIMV + PS vs HFOV
Outcomes	Primary outcome: mortality and BPD Secondary outcomes: days of mechanical ventilation; hospital stay; surfactant requirement; ROP; pulmonary haemorrhage; PDA; NEC; pneumothorax. Moderate or severe disability at 18 months
Notes	SLE5000 and Servo‐i ventilators not analysed: 41 in SIMV, 37 in HFOV group
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Computer‐generated randomisation plan": probably done
Allocation concealment (selection bias)	Low risk	Randomisation stratified by centre, by sex and gestational age using variable block size block randomisation: probably done
Blinding (performance bias and detection bias) All outcomes	High risk	Different ventilators used, no blinding
Blinding of participants and personnel (performance bias) All outcomes	High risk	Different ventilators used, no blinding
Blinding of outcome assessment (detection bias) All outcomes	High risk	Different ventilators used, no blinding
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	High risk for long‐term outcomes with approximately 30% lost to follow‐up Low risk for short‐term outcomes

ACV: assist control ventilation
BPD: bronchopulmonary dysplasia
BW: birth weight
CDH: congenital diaphragmatic hernia
CHD: congenital heart disease
CLD: chronic lung disease
CMV: conventional mechanical ventilation
CPAP: continuous positive airway pressure
ECMO: extracorporeal membrane oxygenation
GA: gestational age
HFO: high‐frequency oscillation
HFOV: high frequency oscillatory ventilation
HFPPV: high‐frequency positive pressure ventilation
IT: inspiratory time
IVH: intraventricular haemorrhage
MAP: mean airway pressure
MAS: meconium aspiration syndrome
NEC: necrotising enterocolitis
OI: oxygenation index
PDA: patent ductus arteriosus
PIE: pulmonary interstitial emphysema
PIP: peak inspiratory pressure
PRVCV: pressure‐regulated volume control ventilation
PS: pressure support
PTV: patient‐triggered ventilation
PVL: periventricular leukomalacia
RDS: respiratory distress syndrome
ROP: retinopathy of prematurity
SIMV: synchronised intermittent mandatory ventilation
SRT: surfactant replacement therapy
VG: volume guarantee

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Abd El‐Moneim 2005	Short‐term cross over study
Abubakar 2005	Randomised short‐term cross over study
Amitay 1993	Not assigned respiratory support mode by randomisation
Bernstein 1993	Not assigned respiratory support mode by randomisation
Bitondo 2012	Adult crossover study of PSV controlled automatically or by clinician
Chan 1993b	Not assigned respiratory support mode by randomisation
Cheema 2001	Short‐term comparison of volume guarantee synchronised ventilation to PTV or SIMV
Clavieras 2013	Adult study comparing methods of pressure support
Cleary 1995	Acute effects of synchronised ventilation
Dani 2006	Short‐term randomised comparison of PSV with VG to HFOV
de la Oliva 2012	Non‐randomised cross‐over study in the paediatric population
De Luca 2009	Cross over trial comparing ACV in time‐cycled and flow‐cycled modality
deBoer 1993	Not assigned respiratory support mode by randomisation
Dimitriou 1998	Comparison of triggering devices
Duman 2012	Comparison of volume targeting vs pressure limited ventilation in one mode of triggered ventilation
Durand 2001	Randomised pilot study comparing HFOV to SIMV
Estay 2009	Assess the effects of flow sensor dead space during SIMV
Firme 2005	Randomised short‐term cross‐over study
Friedlich 1999	Nasopharyngeal SIMV versus CPAP
Greenough 1986	Not assigned respiratory support mode by randomisation
Greenough 1987a	Not assigned respiratory support mode by randomisation
Greenough 1987b	Not assigned respiratory support mode by randomisation
Greenough 1988a	Not assigned respiratory support mode by randomisation
Greenough 1988b	Not assigned respiratory support mode by randomisation
Greenough 1991	Not assigned respiratory support mode by randomisation
Gupta 2008	Quasi‐experimental cross‐over study
Guthrie 2005	Randomised short‐term comparison of SIMV and mandatory minute volume
Guven 2013	Comparison of volume guarantee versus pressure‐limited ventilation in one mode of triggered ventilation
Herrera 2002	Acute effects of volume‐guaranteed SIMV
Hird 1990a	Not assigned respiratory support mode by randomisation
Hird 1990b	Not assigned respiratory support mode by randomisation
Hird 1991a	Not assigned respiratory support mode by randomisation
Hird 1991b	Not assigned respiratory support mode by randomisation
Hird 1991c	Not assigned respiratory support mode by randomisation
Hird 1991d	Not assigned respiratory support mode by randomisation
Hummler 1996	Acute effects of synchronised ventilation
Hummler 1997	Acute effects of mechanical ventilation
Hummler 2006	Randomised short‐term cross‐over study
Jaber 2005	Randomised short‐term cross‐over comparison of PSV and volume support ventilation
Jarreau 1996	Acute outcome of synchronised ventilation
John 1994	Comparison of triggering devices
Kapasi 2001	Short‐term randomised comparison of ventilation modes
Keszler 2004	Short‐term randomised comparison of ventilation modes with ACV with or without volume guarantee
Laubscher 1997	Comparison of triggering devices
Lista 2006	Acute effects of different levels of volume targeting during synchronised intermittent positive pressure ventilation within the context of a randomised trial
Luyt 2001	Acute effects of PTV and conventional ventilation compared within the context of a randomised trial
McCallion 2007	Observational study studying the effects of spontaneous breathing, triggered and untriggered inflations
Migliori 2003	Non randomised comparison of pressure support synchronised ventilation and SIMV
Mitchell 1989	Not assigned respiratory support mode by randomisation
Mizuno 1994	Not assigned respiratory support mode by randomisation
Moretti 1999	Nasal SIPPV to nasal CPAP
Mrozek 2000	Randomised comparison (short‐term) of volume‐targeted synchronised ventilation and CMV
Nacoti 2012	Paediatric study comparing PSV to PSV with sighs. Non‐randomised.
Nafday 2005	Randomised comparison (short‐term) of pressure support with volume guarantee
Nakae 1998	Comparison of triggering devices
Nikischin 1996	Comparison of triggering devices
Nishimura 1995	Comparison of triggering devices
Olsen 2002	Cross‐over trial comparing pressure support with volume guarantee synchronised ventilation to SIMV
Osorio 2005	Cross‐over short‐term comparison of SIMV with or without pressure support
Patel 2009	Cross‐over trial comparing SIMV and SIMV with pressure support
Polimeni 2006	Short‐term cross‐over study
Scopesi 2007	Short‐term cross‐over study
Servant 1992	Not assigned respiratory support mode by randomisation
Smith 1997	Acute outcome of synchronised ventilation
Takeuchi 1994	Not assigned respiratory support mode by randomisation
Thiagarajan 2004	Comparison of triggering devices
Upton 1990	Not assigned respiratory support mode by randomisation
Vishveshwara 1991	Not assigned respiratory support mode by randomisation
Wheeler 2012	Randomised cross‐over trial to study the effects of differing back up rates within one mode of triggered ventilation

Data and analyses

Open in table viewer

Comparison 1. HFPPV vs CMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Death Show forest plot	4	647	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.61, 1.00]
Open in figure viewer Analysis 1.1 Comparison 1: HFPPV vs CMV, Outcome 1: Death
1.2 Air leaks Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.2 Comparison 1: HFPPV vs CMV, Outcome 2: Air leaks
1.2.1 Pneumothorax	3	585	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.51, 0.93]
1.2.2 Pulmonary interstitial emphysema	1	137	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.49, 0.94]
1.3 Total air leak Show forest plot	1	62	Risk Ratio (M‐H, Fixed, 95% CI)	0.25 [0.06, 1.08]
Open in figure viewer Analysis 1.3 Comparison 1: HFPPV vs CMV, Outcome 3: Total air leak
1.4 BPD (oxygen dependency at 28 days) Show forest plot	4	647	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.77, 1.46]
Open in figure viewer Analysis 1.4 Comparison 1: HFPPV vs CMV, Outcome 4: BPD (oxygen dependency at 28 days)
1.5 IVH Show forest plot	1	62	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.02, 0.94]
Open in figure viewer Analysis 1.5 Comparison 1: HFPPV vs CMV, Outcome 5: IVH

Open in table viewer

Comparison 2. ACV/SIMV vs CMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Death Show forest plot	6	1790	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.94, 1.47]
Open in figure viewer Analysis 2.1 Comparison 2: ACV/SIMV vs CMV, Outcome 1: Death
2.2 Air leaks Show forest plot	7	1830	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.76, 1.27]
Open in figure viewer Analysis 2.2 Comparison 2: ACV/SIMV vs CMV, Outcome 2: Air leaks
2.3 Duration of ventilation (hours) Show forest plot	5	1463	Mean Difference (IV, Fixed, 95% CI)	‐38.30 [‐53.90, ‐22.69]
Open in figure viewer Analysis 2.3 Comparison 2: ACV/SIMV vs CMV, Outcome 3: Duration of ventilation (hours)
2.4 Extubation failure Show forest plot	4	1056	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.68, 1.28]
Open in figure viewer Analysis 2.4 Comparison 2: ACV/SIMV vs CMV, Outcome 4: Extubation failure
2.5 Severe IVH Show forest plot	6	1790	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.73, 1.40]
Open in figure viewer Analysis 2.5 Comparison 2: ACV/SIMV vs CMV, Outcome 5: Severe IVH
2.6 BPD (oxygen dependency at 28 days) Show forest plot	4	805	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.75, 1.12]
Open in figure viewer Analysis 2.6 Comparison 2: ACV/SIMV vs CMV, Outcome 6: BPD (oxygen dependency at 28 days)
2.7 Moderate/Severe BPD (oxygen dependent at 36 weeks PCA) Show forest plot	2	1310	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.75, 1.08]
Open in figure viewer Analysis 2.7 Comparison 2: ACV/SIMV vs CMV, Outcome 7: Moderate/Severe BPD (oxygen dependent at 36 weeks PCA)

Open in table viewer

Comparison 3. SIMV or SIMV + PS vs HFOV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Death Show forest plot	4	996	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.91, 1.71]
Open in figure viewer Analysis 3.1 Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 1: Death
3.2 BPD: oxygen requirement at 28 days Show forest plot	1	110	Risk Ratio (M‐H, Fixed, 95% CI)	3.21 [0.37, 27.83]
Open in figure viewer Analysis 3.2 Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 2: BPD: oxygen requirement at 28 days
3.3 Moderate/ Severe BPD: Oxygen requirement at 36 weeks PCA Show forest plot	3	869	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [1.07, 1.65]
Open in figure viewer Analysis 3.3 Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 3: Moderate/ Severe BPD: Oxygen requirement at 36 weeks PCA
3.4 Death or BPD Show forest plot	1	356	Risk Ratio (M‐H, Fixed, 95% CI)	2.38 [1.41, 4.03]
Open in figure viewer Analysis 3.4 Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 4: Death or BPD
3.5 Duration of mechanical ventilation Show forest plot	2	466	Mean Difference (IV, Fixed, 95% CI)	1.89 [1.04, 2.74]
Open in figure viewer Analysis 3.5 Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 5: Duration of mechanical ventilation
3.6 Air leaks Show forest plot	3	1398	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.70, 1.19]
Open in figure viewer Analysis 3.6 Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 6: Air leaks
3.6.1 Pulmonary interstitial emphysema	1	498	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.44, 0.99]
3.6.2 Pneumothorax	3	900	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.82, 1.64]
3.7 IVH Grade 3/4 Show forest plot	4	1010	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.71, 1.24]
Open in figure viewer Analysis 3.7 Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 7: IVH Grade 3/4

Open in table viewer

Comparison 4. ACV vs SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Duration of weaning (hours) Show forest plot	3	120	Mean Difference (IV, Fixed, 95% CI)	‐42.38 [‐94.35, 9.60]
Open in figure viewer Analysis 4.1 Comparison 4: ACV vs SIMV, Outcome 1: Duration of weaning (hours)
4.2 Weaning failure Show forest plot	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.31, 1.93]
Open in figure viewer Analysis 4.2 Comparison 4: ACV vs SIMV, Outcome 2: Weaning failure
4.3 Extubation failure Show forest plot	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.37, 2.67]
Open in figure viewer Analysis 4.3 Comparison 4: ACV vs SIMV, Outcome 3: Extubation failure
4.4 Air leaks Show forest plot	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.23, 2.83]
Open in figure viewer Analysis 4.4 Comparison 4: ACV vs SIMV, Outcome 4: Air leaks
4.4.1 Total air leaks	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.23, 2.83]

Open in table viewer

Comparison 5. PS + SIMV versus SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 Death Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 5.1 Comparison 5: PS + SIMV versus SIMV, Outcome 1: Death
5.1.1 Death during first 28 days	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.08, 2.01]
5.1.2 Death prior to discharge	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.31, 2.43]
5.2 Air leaks Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 5.2 Comparison 5: PS + SIMV versus SIMV, Outcome 2: Air leaks
5.2.1 Pneumothorax	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
5.2.2 Pulmonary interstitial emphysema	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.25, 2.15]
5.3 BPD Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 5.3 Comparison 5: PS + SIMV versus SIMV, Outcome 3: BPD
5.3.1 BPD (oxygen dependency at 28 days)	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.84, 1.23]
5.3.2 Moderate/Severe BPD (oxygen dependency at 36 weeks PMA)	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.42, 1.18]
5.4 Severe IVH (grade III and IV) Show forest plot	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.41, 2.08]
Open in figure viewer Analysis 5.4 Comparison 5: PS + SIMV versus SIMV, Outcome 4: Severe IVH (grade III and IV)

Open in table viewer

Comparison 6. PRVCV vs SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 Death prior to discharge Show forest plot	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.50, 2.11]
Open in figure viewer Analysis 6.1 Comparison 6: PRVCV vs SIMV, Outcome 1: Death prior to discharge
6.2 BPD: oxygen requirement at 36 weeks in survivors Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.55, 1.27]
Open in figure viewer Analysis 6.2 Comparison 6: PRVCV vs SIMV, Outcome 2: BPD: oxygen requirement at 36 weeks in survivors
6.3 Air leak Show forest plot	1	424	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.51, 2.13]
Open in figure viewer Analysis 6.3 Comparison 6: PRVCV vs SIMV, Outcome 3: Air leak
6.3.1 PIE	1	212	Risk Ratio (M‐H, Fixed, 95% CI)	1.66 [0.56, 4.91]
6.3.2 Pneumothorax	1	212	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.26, 1.88]
6.4 Severe IVH Show forest plot	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.29, 1.58]
Open in figure viewer Analysis 6.4 Comparison 6: PRVCV vs SIMV, Outcome 4: Severe IVH

Open in table viewer

Comparison 7. PSV vs SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 Duration of weaning Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	‐11.30 [‐26.53, 3.93]
Open in figure viewer Analysis 7.1 Comparison 7: PSV vs SIMV, Outcome 1: Duration of weaning
7.2 Extubation failure Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.57, 2.07]
Open in figure viewer Analysis 7.2 Comparison 7: PSV vs SIMV, Outcome 2: Extubation failure
7.3 Air leaks (total) Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.00]
Open in figure viewer Analysis 7.3 Comparison 7: PSV vs SIMV, Outcome 3: Air leaks (total)
7.4 Moderate/Severe BPD: oxygen requirement at 36 weeks PCA Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.46, 2.17]
Open in figure viewer Analysis 7.4 Comparison 7: PSV vs SIMV, Outcome 4: Moderate/Severe BPD: oxygen requirement at 36 weeks PCA

Open in table viewer

Comparison 8. ACV versus PSV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

8.1 Duration of weaning Show forest plot

1

Other data

No numeric data

Analysis 8.1

Study	Participants	Duration of weaning ACV (Median (range))	Duration of weaning PSV (Median(range))	Significance
Duration of weaning
Patel 2012	36	34 (7‐100)	27 (10‐169)	p=0.88

Comparison 8: ACV versus PSV, Outcome 1: Duration of weaning

Figure 1

Study flow diagram: review update

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Analysis 1.1

Comparison 1: HFPPV vs CMV, Outcome 1: Death

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Analysis 1.2

Comparison 1: HFPPV vs CMV, Outcome 2: Air leaks

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Analysis 1.3

Comparison 1: HFPPV vs CMV, Outcome 3: Total air leak

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Analysis 1.4

Comparison 1: HFPPV vs CMV, Outcome 4: BPD (oxygen dependency at 28 days)

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Analysis 1.5

Comparison 1: HFPPV vs CMV, Outcome 5: IVH

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Analysis 2.1

Comparison 2: ACV/SIMV vs CMV, Outcome 1: Death

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Analysis 2.2

Comparison 2: ACV/SIMV vs CMV, Outcome 2: Air leaks

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Analysis 2.3

Comparison 2: ACV/SIMV vs CMV, Outcome 3: Duration of ventilation (hours)

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Analysis 2.4

Comparison 2: ACV/SIMV vs CMV, Outcome 4: Extubation failure

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Analysis 2.5

Comparison 2: ACV/SIMV vs CMV, Outcome 5: Severe IVH

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Analysis 2.6

Comparison 2: ACV/SIMV vs CMV, Outcome 6: BPD (oxygen dependency at 28 days)

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Analysis 2.7

Comparison 2: ACV/SIMV vs CMV, Outcome 7: Moderate/Severe BPD (oxygen dependent at 36 weeks PCA)

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Analysis 3.1

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 1: Death

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Analysis 3.2

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 2: BPD: oxygen requirement at 28 days

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Analysis 3.3

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 3: Moderate/ Severe BPD: Oxygen requirement at 36 weeks PCA

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Analysis 3.4

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 4: Death or BPD

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Analysis 3.5

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 5: Duration of mechanical ventilation

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Analysis 3.6

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 6: Air leaks

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Analysis 3.7

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 7: IVH Grade 3/4

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Analysis 4.1

Comparison 4: ACV vs SIMV, Outcome 1: Duration of weaning (hours)

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Analysis 4.2

Comparison 4: ACV vs SIMV, Outcome 2: Weaning failure

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Analysis 4.3

Comparison 4: ACV vs SIMV, Outcome 3: Extubation failure

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Analysis 4.4

Comparison 4: ACV vs SIMV, Outcome 4: Air leaks

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Analysis 5.1

Comparison 5: PS + SIMV versus SIMV, Outcome 1: Death

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Analysis 5.2

Comparison 5: PS + SIMV versus SIMV, Outcome 2: Air leaks

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Analysis 5.3

Comparison 5: PS + SIMV versus SIMV, Outcome 3: BPD

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Analysis 5.4

Comparison 5: PS + SIMV versus SIMV, Outcome 4: Severe IVH (grade III and IV)

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Analysis 6.1

Comparison 6: PRVCV vs SIMV, Outcome 1: Death prior to discharge

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Analysis 6.2

Comparison 6: PRVCV vs SIMV, Outcome 2: BPD: oxygen requirement at 36 weeks in survivors

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Analysis 6.3

Comparison 6: PRVCV vs SIMV, Outcome 3: Air leak

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Analysis 6.4

Comparison 6: PRVCV vs SIMV, Outcome 4: Severe IVH

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Analysis 7.1

Comparison 7: PSV vs SIMV, Outcome 1: Duration of weaning

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Analysis 7.2

Comparison 7: PSV vs SIMV, Outcome 2: Extubation failure

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Analysis 7.3

Comparison 7: PSV vs SIMV, Outcome 3: Air leaks (total)

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Analysis 7.4

Comparison 7: PSV vs SIMV, Outcome 4: Moderate/Severe BPD: oxygen requirement at 36 weeks PCA

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Study	Participants	Duration of weaning ACV (Median (range))	Duration of weaning PSV (Median(range))	Significance
Duration of weaning
Patel 2012	36	34 (7‐100)	27 (10‐169)	p=0.88

Analysis 8.1

Comparison 8: ACV versus PSV, Outcome 1: Duration of weaning

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Comparison 1. HFPPV vs CMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Death Show forest plot	4	647	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.61, 1.00]

1.2 Air leaks Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.2.1 Pneumothorax	3	585	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.51, 0.93]
1.2.2 Pulmonary interstitial emphysema	1	137	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.49, 0.94]
1.3 Total air leak Show forest plot	1	62	Risk Ratio (M‐H, Fixed, 95% CI)	0.25 [0.06, 1.08]

1.4 BPD (oxygen dependency at 28 days) Show forest plot	4	647	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.77, 1.46]

1.5 IVH Show forest plot	1	62	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.02, 0.94]

Comparison 1. HFPPV vs CMV

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Comparison 2. ACV/SIMV vs CMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Death Show forest plot	6	1790	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.94, 1.47]

2.2 Air leaks Show forest plot	7	1830	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.76, 1.27]

2.3 Duration of ventilation (hours) Show forest plot	5	1463	Mean Difference (IV, Fixed, 95% CI)	‐38.30 [‐53.90, ‐22.69]

2.4 Extubation failure Show forest plot	4	1056	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.68, 1.28]

2.5 Severe IVH Show forest plot	6	1790	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.73, 1.40]

2.6 BPD (oxygen dependency at 28 days) Show forest plot	4	805	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.75, 1.12]

2.7 Moderate/Severe BPD (oxygen dependent at 36 weeks PCA) Show forest plot	2	1310	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.75, 1.08]

Comparison 2. ACV/SIMV vs CMV

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Comparison 3. SIMV or SIMV + PS vs HFOV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Death Show forest plot	4	996	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.91, 1.71]

3.2 BPD: oxygen requirement at 28 days Show forest plot	1	110	Risk Ratio (M‐H, Fixed, 95% CI)	3.21 [0.37, 27.83]

3.3 Moderate/ Severe BPD: Oxygen requirement at 36 weeks PCA Show forest plot	3	869	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [1.07, 1.65]

3.4 Death or BPD Show forest plot	1	356	Risk Ratio (M‐H, Fixed, 95% CI)	2.38 [1.41, 4.03]

3.5 Duration of mechanical ventilation Show forest plot	2	466	Mean Difference (IV, Fixed, 95% CI)	1.89 [1.04, 2.74]

3.6 Air leaks Show forest plot	3	1398	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.70, 1.19]

3.6.1 Pulmonary interstitial emphysema	1	498	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.44, 0.99]
3.6.2 Pneumothorax	3	900	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.82, 1.64]
3.7 IVH Grade 3/4 Show forest plot	4	1010	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.71, 1.24]

Comparison 3. SIMV or SIMV + PS vs HFOV

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Comparison 4. ACV vs SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Duration of weaning (hours) Show forest plot	3	120	Mean Difference (IV, Fixed, 95% CI)	‐42.38 [‐94.35, 9.60]

4.2 Weaning failure Show forest plot	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.31, 1.93]

4.3 Extubation failure Show forest plot	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.37, 2.67]

4.4 Air leaks Show forest plot	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.23, 2.83]

4.4.1 Total air leaks	3	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.23, 2.83]

Comparison 4. ACV vs SIMV

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Comparison 5. PS + SIMV versus SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 Death Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.1.1 Death during first 28 days	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.08, 2.01]
5.1.2 Death prior to discharge	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.31, 2.43]
5.2 Air leaks Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.2.1 Pneumothorax	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
5.2.2 Pulmonary interstitial emphysema	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.25, 2.15]
5.3 BPD Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.3.1 BPD (oxygen dependency at 28 days)	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.84, 1.23]
5.3.2 Moderate/Severe BPD (oxygen dependency at 36 weeks PMA)	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.42, 1.18]
5.4 Severe IVH (grade III and IV) Show forest plot	1	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.41, 2.08]

Comparison 5. PS + SIMV versus SIMV

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Comparison 6. PRVCV vs SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 Death prior to discharge Show forest plot	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.50, 2.11]

6.2 BPD: oxygen requirement at 36 weeks in survivors Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.55, 1.27]

6.3 Air leak Show forest plot	1	424	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.51, 2.13]

6.3.1 PIE	1	212	Risk Ratio (M‐H, Fixed, 95% CI)	1.66 [0.56, 4.91]
6.3.2 Pneumothorax	1	212	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.26, 1.88]
6.4 Severe IVH Show forest plot	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.29, 1.58]

Comparison 6. PRVCV vs SIMV

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Comparison 7. PSV vs SIMV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 Duration of weaning Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	‐11.30 [‐26.53, 3.93]

7.2 Extubation failure Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.57, 2.07]

7.3 Air leaks (total) Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.00]

7.4 Moderate/Severe BPD: oxygen requirement at 36 weeks PCA Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.46, 2.17]

Comparison 7. PSV vs SIMV

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Comparison 8. ACV versus PSV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
8.1 Duration of weaning Show forest plot	1		Other data	No numeric data

Comparison 8. ACV versus PSV

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Referencias

References to studies included in this review

Amini 2013 {published data only}

Baumer 2000 {published data only}

Beresford 2000 {published data only}

Bernstein 1996 {published data only}

Chan 1993 {published data only}

Chan 1994 {published data only}

Chen 1997 {published data only}

Courtney 2002a {published data only}

Craft 2003a {published data only}

D'Angio 2005 {published data only}

Dimitriou 1995a {published data only}

Dimitriou 1995b {published data only}

Donn 1994 {published data only}

Erdemir 2014 {published data only}

Heicher 1981 {published data only}

Liu 2011 {published data only}

OCTAVE 1991 {published data only}

Patel 2012 {published data only}

Pohlandt 1992 {published data only}

Reyes 2006 {published data only}

Singh 2012 {published data only}

Sun 2014 {published data only}

References to studies excluded from this review

Abd El‐Moneim 2005 {published data only}

Abubakar 2005 {published data only}

Amitay 1993 {published data only}

Bernstein 1993 {published data only}

Bitondo 2012 {published data only}

Chan 1993b {published data only}

Cheema 2001 {published data only}

Clavieras 2013 {published data only}

Cleary 1995 {published data only}

Dani 2006 {published data only}

deBoer 1993 {published data only}

de la Oliva 2012 {published data only}

De Luca 2009 {published data only}

Dimitriou 1998 {published data only}

Duman 2012 {published data only}

Durand 2001 {published data only}

Estay 2009 {published data only}

Firme 2005 {published data only}

Friedlich 1999 {published data only}

Greenough 1986 {published data only}

Greenough 1987a {published data only}

Greenough 1987b {published data only}

Greenough 1988a {published data only}

Greenough 1988b {published data only}

Greenough 1991 {published data only}

Gupta 2008 {published data only}

Guthrie 2005 {published data only}

Guven 2013 {published data only}

Herrera 2002 {published data only}

Hird 1990a {published data only}

Hird 1990b {published data only}

Hird 1991a {published data only}

Hird 1991b {published data only}

Hird 1991c {published data only}

Hird 1991d {published data only}

Hummler 1996 {published data only}

Hummler 1997 {published data only}

Hummler 2006 {published data only}

Jaber 2005 {published data only}

Jarreau 1996 {published data only}

John 1994 {published data only}

Kapasi 2001 {published data only}

Keszler 2004 {published data only}

Laubscher 1997 {published data only}

Lista 2006 {published data only}

Luyt 2001 {published data only}

McCallion 2007 {published data only}

Migliori 2003 {published data only}

Mitchell 1989 {published data only}

Mizuno 1994 {published data only}

Moretti 1999 {published data only}

Mrozek 2000 {published data only}

Nacoti 2012 {published data only}