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

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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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