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Study flow diagram: review update. PLV: pressure‐limited ventilation; VTV: volume‐targeted ventilation.
Figuras y tablas -
Figure 1

Study flow diagram: review update. PLV: pressure‐limited ventilation; VTV: volume‐targeted ventilation.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 1 Death before discharge from hospital.
Figuras y tablas -
Analysis 1.1

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 1 Death before discharge from hospital.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 2 Death or bronchopulmonary dysplasia (BPD) (36 weeks).
Figuras y tablas -
Analysis 1.2

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 2 Death or bronchopulmonary dysplasia (BPD) (36 weeks).

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 3 Failure of mode of ventilation.
Figuras y tablas -
Analysis 1.3

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 3 Failure of mode of ventilation.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 4 Addition of neuromuscular paralysis where previously not paralysed.
Figuras y tablas -
Analysis 1.4

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 4 Addition of neuromuscular paralysis where previously not paralysed.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 5 Duration of positive pressure ventilation (days, survivors).
Figuras y tablas -
Analysis 1.5

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 5 Duration of positive pressure ventilation (days, survivors).

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 6 Duration of positive pressure ventilation (log data, survivors).
Figuras y tablas -
Analysis 1.6

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 6 Duration of positive pressure ventilation (log data, survivors).

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 7 Inspired oxygen concentration % (study definition).
Figuras y tablas -
Analysis 1.7

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 7 Inspired oxygen concentration % (study definition).

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 8 Any pH < 7.25.
Figuras y tablas -
Analysis 1.8

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 8 Any pH < 7.25.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 9 Hypocarbia partial pressure of carbon dioxide (pCO2) < 35 mmHg/4.7 kPa.
Figuras y tablas -
Analysis 1.9

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 9 Hypocarbia partial pressure of carbon dioxide (pCO2) < 35 mmHg/4.7 kPa.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 10 Respiratory acidosis; pH < 7.25 and pCO2 > 8 kPa.
Figuras y tablas -
Analysis 1.10

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 10 Respiratory acidosis; pH < 7.25 and pCO2 > 8 kPa.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 11 Incidence of hypocarbia or respiratory acidosis.
Figuras y tablas -
Analysis 1.11

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 11 Incidence of hypocarbia or respiratory acidosis.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 12 Patent ductus arteriosus.
Figuras y tablas -
Analysis 1.12

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 12 Patent ductus arteriosus.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 13 Air leak (any).
Figuras y tablas -
Analysis 1.13

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 13 Air leak (any).

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 14 Pneumothorax.
Figuras y tablas -
Analysis 1.14

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 14 Pneumothorax.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 15 Pulmonary interstitial emphysema.
Figuras y tablas -
Analysis 1.15

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 15 Pulmonary interstitial emphysema.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 16 Any intraventricular haemorrhage (IVH).
Figuras y tablas -
Analysis 1.16

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 16 Any intraventricular haemorrhage (IVH).

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 17 Periventricular leukomalacia (PVL).
Figuras y tablas -
Analysis 1.17

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 17 Periventricular leukomalacia (PVL).

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 18 IVH grade 3‐4.
Figuras y tablas -
Analysis 1.18

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 18 IVH grade 3‐4.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 19 Any IVH or PVL.
Figuras y tablas -
Analysis 1.19

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 19 Any IVH or PVL.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 20 IVH grade 3‐4 or PVL.
Figuras y tablas -
Analysis 1.20

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 20 IVH grade 3‐4 or PVL.

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Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 21 BPD (supplemental oxygen in survivors at 36 weeks only).
Figuras y tablas -
Analysis 1.21

Comparison 1 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation, Outcome 21 BPD (supplemental oxygen in survivors at 36 weeks only).

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 1 Death in hospital.
Figuras y tablas -
Analysis 2.1

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 1 Death in hospital.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 2 Death or bronchopulmonary dysplasia (BPD) (36 weeks).
Figuras y tablas -
Analysis 2.2

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 2 Death or bronchopulmonary dysplasia (BPD) (36 weeks).

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 3 Duration of positive pressure ventilation (days, survivors).
Figuras y tablas -
Analysis 2.3

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 3 Duration of positive pressure ventilation (days, survivors).

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 4 Duration of positive pressure ventilation (log data, survivors).
Figuras y tablas -
Analysis 2.4

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 4 Duration of positive pressure ventilation (log data, survivors).

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 5 Any pH < 7.25.
Figuras y tablas -
Analysis 2.5

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 5 Any pH < 7.25.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 6 Hypocarbia partial pressure of carbon dioxide (pCO2) < 35 mmHg/4.7 kPa.
Figuras y tablas -
Analysis 2.6

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 6 Hypocarbia partial pressure of carbon dioxide (pCO2) < 35 mmHg/4.7 kPa.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 7 Respiratory acidosis pH < 7.25 and pCO2 > 60 mmHg/8 kPa.
Figuras y tablas -
Analysis 2.7

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 7 Respiratory acidosis pH < 7.25 and pCO2 > 60 mmHg/8 kPa.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 8 Hypocarbia or respiratory acidosis.
Figuras y tablas -
Analysis 2.8

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 8 Hypocarbia or respiratory acidosis.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 9 Patent ductus arteriosus.
Figuras y tablas -
Analysis 2.9

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 9 Patent ductus arteriosus.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 10 Air leak (any).
Figuras y tablas -
Analysis 2.10

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 10 Air leak (any).

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 11 Pneumothorax.
Figuras y tablas -
Analysis 2.11

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 11 Pneumothorax.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 12 Pulmonary interstitial emphysema.
Figuras y tablas -
Analysis 2.12

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 12 Pulmonary interstitial emphysema.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 13 Any intraventricular haemorrhage (IVH).
Figuras y tablas -
Analysis 2.13

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 13 Any intraventricular haemorrhage (IVH).

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 14 IVH grade 3‐4.
Figuras y tablas -
Analysis 2.14

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 14 IVH grade 3‐4.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 15 Periventricular leukomalacia (PVL).
Figuras y tablas -
Analysis 2.15

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 15 Periventricular leukomalacia (PVL).

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 16 Any IVH or PVL.
Figuras y tablas -
Analysis 2.16

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 16 Any IVH or PVL.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 17 IVH grade 3‐4 or PVL.
Figuras y tablas -
Analysis 2.17

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 17 IVH grade 3‐4 or PVL.

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Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 18 BPD (supplemental oxygen in survivors at 36 weeks).
Figuras y tablas -
Analysis 2.18

Comparison 2 Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g, Outcome 18 BPD (supplemental oxygen in survivors at 36 weeks).

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Comparison 3 Miscellaneous post hoc analyses, Outcome 1 Severe disability (any definition).
Figuras y tablas -
Analysis 3.1

Comparison 3 Miscellaneous post hoc analyses, Outcome 1 Severe disability (any definition).

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Comparison 3 Miscellaneous post hoc analyses, Outcome 2 Severe disability (any definition) or death.
Figuras y tablas -
Analysis 3.2

Comparison 3 Miscellaneous post hoc analyses, Outcome 2 Severe disability (any definition) or death.

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Comparison 3 Miscellaneous post hoc analyses, Outcome 3 Gross motor developmental issue (any definition).
Figuras y tablas -
Analysis 3.3

Comparison 3 Miscellaneous post hoc analyses, Outcome 3 Gross motor developmental issue (any definition).

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Comparison 3 Miscellaneous post hoc analyses, Outcome 4 Steroids for bronchopulmonary dysplasia.
Figuras y tablas -
Analysis 3.4

Comparison 3 Miscellaneous post hoc analyses, Outcome 4 Steroids for bronchopulmonary dysplasia.

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Comparison 3 Miscellaneous post hoc analyses, Outcome 5 Need for home oxygen (survivors).
Figuras y tablas -
Analysis 3.5

Comparison 3 Miscellaneous post hoc analyses, Outcome 5 Need for home oxygen (survivors).

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Comparison 3 Miscellaneous post hoc analyses, Outcome 6 Need for home oxygen (survivors weighing < 1000 g).
Figuras y tablas -
Analysis 3.6

Comparison 3 Miscellaneous post hoc analyses, Outcome 6 Need for home oxygen (survivors weighing < 1000 g).

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Summary of findings for the main comparison. Volume‐targeted compared to pressure‐limited ventilation: main findings

Volume‐targeted ventilation compared to pressure‐limited ventilation

Patient or population: neonates up to 44 weeks' postmenstrual age
Setting: neonatal intensive care unit
Intervention: VTV
Comparison: PLV

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with PLV

Risk with VTV

Death before discharge from hospital

Study population

RR 0.75
(0.53 to 1.07)

771
(11 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates. 95% CI < 0.75.

163 per 1000

122 per 1000
(86 to 175)

Death or BPD (36 weeks)

Study population

RR 0.73
(0.59 to 0.89)

584
(8 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

458 per 1000

334 per 1000
(270 to 408)

Duration of positive pressure ventilation (days)

MD of positive pressure ventilation (days); PLV group 0

MD 1.35 lower
(1.83 lower to 0.86 lower) in VTV group

‐

736
(12 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

Pneumothorax

Study population

RR 0.52 (0.31 to 0.87)

825
(13 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

88 per 1000

46 per 1000

(27 to 77)

IVH grade 3‐4

Study population

RR 0.53

(0.37 to 0.77)

712

(10 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

184 per 1000

97 per 1000

(68 to 141)

IVH grade 3‐4 or PVL

Study population

RR 0.47

(0.27 to 0.80)

441
(6 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

164 per 1000

77 per 1000

(44 to 131)

BPD (supplemental oxygen at 36 weeks)

Study population

RR 0.68 (0.53 to 0.87)

620
(9 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Possible publication bias based on funnel plot.

346 per 1000

235 per 1000

(183 to 301)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

BPD: bronchopulmonary dysplasia; CI: confidence interval; IVH: intraventricular haemorrhage; MD: mean difference; PLV: pressure‐limited ventilation; PVL: periventricular leukomalacia; RCT: randomised controlled trial; RR: risk ratio; VTV: volume‐targeted ventilation.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Figuras y tablas -
Summary of findings for the main comparison. Volume‐targeted compared to pressure‐limited ventilation: main findings
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Summary of findings 2. Volume‐targeted compared to pressure‐limited ventilation: additional findings

Volume‐targeted ventilation compared to pressure‐limited ventilation

Patient or population: neonates up to 44 weeks' postmenstrual age
Setting: neonatal intensive care unit
Intervention: VTV
Comparison: PLV

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with PLV

Risk with VTV

Death or BPD (28 days)

Study population

RR 0.87 (0.64 to 1.18)

149
(3 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates, 95% CI < 0.75. Few participants.

536 per 1000

467 per 1000

(343 to 633)

Failure of mode of ventilation

Study population

RR 0.69
(0.48 to 1.00)

445
(5 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

242 per 1000

167 per 1000
(116 to 242)

Addition of neuromuscular paralysis where previously not paralysed

Study population

RR 0.32
(0.07 to 1.40)

75
(2 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Small numbers of participants.

179 per 1000

57 per 1000
(13 to 251)

Duration of positive pressure ventilation (log data)

The mean duration of IPPV (log data) was 0

MD 0.08 lower
(0.16 lower to 0)

‐

381
(5 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Heterogeneity of study results.

Inspired oxygen concentration % (study definition)

The mean difference in inspired oxygen concentration %;

PLV group 0

The mean inspired oxygen concentration % was 0.92 lower (2.08 lower to 0.24 higher) in VTV group

‐

324
(7 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

Any pH < 7.25

Study population

RR 0.80
(0.52 to 1.23)

98
(3 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates, 95% CI < 0.75. Few participants.

380 per 1000

304 per 1000
(198 to 467)

Hypocarbia

pCO2 < 35 mmHg/4.7 kPa

Study population

RR 0.49 (0.33 to 0.72)

98
(3 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies. Small trials, but large effect and biologically plausible.

720 per 1000

353 per 1000

(238 to 518)

Respiratory acidosis

pH < 7.25 and pCO2 > 60 mmHg/8 kPa

Study population

RR 0.93
(0.51 to 1.70)

98
(3 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates, 95% CI < 0.75. Few participants.

240 per 1000

223 per 1000
(122 to 408)

Either hypocarbia or respiratory acidosis

Study population

RR 0.68
(0.42 to 1.10)

37
(2 RCTs)

‐

No quality assessment possible.

1889 per 1000

1000 per 1000
(793 to 1000)

Patent ductus arteriosus

Study population

RR 0.95
(0.80 to 1.12)

754
(10 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Variable diagnostic practices employed.

391 per 1000

371 per 1000
(313 to 438)

Air leak (any)

Study population

RR 0.79
(0.44 to 1.43)

374
(5 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates, 95% CI < 0.75. Few participants.

117 per 1000

92 per 1000
(51 to 167)

Pulmonary interstitial emphysema

Study population

RR 1.21
(0.63 to 2.30)

430
(6 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates, 95% CI < 0.75.

65 per 1000

79 per 1000
(41 to 150)

Any IVH

Study population

RR 0.82
(0.62 to 1.08)

445
(5 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates, 95% CI < 0.75.

342 per 1000

281 per 1000
(212 to 370)

PVL

Study population

OR 0.43

(0.19 to 0.98)

508
(7 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

71 per 1000

32 per 1000

(14 to 69)

Any IVH or PVL

Study population

RR 0.83
(0.58 to 1.18)

298
(3 RCTs)

⊕⊕⊕⊝
Moderate

Unblinded studies.

308 per 1000

256 per 1000
(179 to 364)

BPD (supplemental oxygen at 28 days)

Study population

RR 0.91
(0.64 to 1.30)

206
(4 RCTs)

⊕⊕⊝⊝
Low

Unblinded studies. Imprecision of estimates, 95% CI < 0.75.

354 per 1000

322 per 1000
(226 to 460)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

BPD: bronchopulmonary dysplasia; CI: confidence interval; IPPV: intermittent positive pressure ventilation; IVH: intraventricular haemorrhage; MD: mean difference; pCO2: partial pressure of carbon dioxide; PLV: pressure‐limited ventilation; PVL: periventricular leukomalacia; RCT: randomised controlled trial; RR: risk ratio; VTV: volume‐targeted ventilation.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Figuras y tablas -
Summary of findings 2. Volume‐targeted compared to pressure‐limited ventilation: additional findings
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Comparison 1. Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death before discharge from hospital Show forest plot

11

771

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.53, 1.07]

1.1 Strict studies

4

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.31, 1.15]

1.2 Hybrid studies

7

551

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.55, 1.25]

2 Death or bronchopulmonary dysplasia (BPD) (36 weeks) Show forest plot

8

584

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.59, 0.89]

2.1 Strict studies

4

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.50, 0.94]

2.2 Hybrid studies

4

364

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.58, 0.99]

3 Failure of mode of ventilation Show forest plot

5

445

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.48, 1.00]

3.1 Strict studies

2

149

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.44, 1.72]

3.2 Hybrid studies

3

296

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.40, 0.97]

4 Addition of neuromuscular paralysis where previously not paralysed Show forest plot

2

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.07, 1.40]

4.1 Strict studies

1

18

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Hybrid studies

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.07, 1.40]

5 Duration of positive pressure ventilation (days, survivors) Show forest plot

12

736

Mean Difference (IV, Fixed, 95% CI)

‐1.35 [‐1.83, ‐0.86]

5.1 Strict studies

5

229

Mean Difference (IV, Fixed, 95% CI)

‐2.08 [‐3.51, ‐0.64]

5.2 Hybrid studies

7

507

Mean Difference (IV, Fixed, 95% CI)

‐1.25 [‐1.77, ‐0.74]

6 Duration of positive pressure ventilation (log data, survivors) Show forest plot

5

381

Mean Difference (IV, Fixed, 95% CI)

‐0.08 [‐0.16, ‐0.00]

6.1 Strict studies

3

152

Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐0.24, ‐0.04]

6.2 Hybrid studies

2

229

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.12, 0.15]

7 Inspired oxygen concentration % (study definition) Show forest plot

7

324

Mean Difference (IV, Fixed, 95% CI)

‐0.92 [‐2.08, 0.24]

7.1 Parallel studies

3

156

Mean Difference (IV, Fixed, 95% CI)

‐1.42 [‐3.09, 0.24]

7.2 Cross‐over studies

4

168

Mean Difference (IV, Fixed, 95% CI)

‐0.44 [‐2.05, 1.17]

8 Any pH < 7.25 Show forest plot

3

98

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.52, 1.23]

9 Hypocarbia partial pressure of carbon dioxide (pCO2) < 35 mmHg/4.7 kPa Show forest plot

3

98

Risk Ratio (M‐H, Fixed, 95% CI)

0.49 [0.33, 0.72]

10 Respiratory acidosis; pH < 7.25 and pCO2 > 8 kPa Show forest plot

3

98

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.51, 1.70]

11 Incidence of hypocarbia or respiratory acidosis Show forest plot

2

58

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.42, 1.12]

12 Patent ductus arteriosus Show forest plot

10

754

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.80, 1.12]

12.1 Strict studies

3

202

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.61, 1.08]

12.2 Hybrid studies

7

552

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.83, 1.25]

13 Air leak (any) Show forest plot

5

374

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.44, 1.43]

13.1 Strict studies

2

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.09, 2.81]

13.2 Hybrid Studies

3

303

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.45, 1.58]

14 Pneumothorax Show forest plot

13

825

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.31, 0.87]

14.1 Strict studies

5

250

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.19, 1.44]

14.2 Hybrid studies

8

575

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.28, 0.94]

15 Pulmonary interstitial emphysema Show forest plot

6

430

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.63, 2.30]

15.1 Strict studies

2

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.12, 5.04]

15.2 Hybrid studies

4

359

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.64, 2.57]

16 Any intraventricular haemorrhage (IVH) Show forest plot

6

501

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.70, 1.15]

16.1 Strict studies

2

125

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.74, 1.67]

16.2 Hybrid studies

4

376

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.60, 1.11]

17 Periventricular leukomalacia (PVL) Show forest plot

7

508

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.21, 0.98]

17.1 Strict studies

4

218

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.17, 1.65]

17.2 Hybrid studies

3

290

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.14, 1.14]

18 IVH grade 3‐4 Show forest plot

10

712

Risk Difference (M‐H, Fixed, 95% CI)

‐0.09 [‐0.14, ‐0.04]

18.1 Strict studies

4

218

Risk Difference (M‐H, Fixed, 95% CI)

‐0.05 [‐0.13, 0.02]

18.2 Hybrid studies

6

494

Risk Difference (M‐H, Fixed, 95% CI)

‐0.10 [‐0.17, ‐0.04]

19 Any IVH or PVL Show forest plot

3

298

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.58, 1.18]

19.1 Strict studies

2

125

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.52, 1.35]

19.2 Hybrid studies

1

173

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.48, 1.39]

20 IVH grade 3‐4 or PVL Show forest plot

6

441

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.27, 0.80]

20.1 Strict studies

4

218

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.25, 1.03]

20.2 Hybrid studies

2

223

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.19, 0.96]

21 BPD (supplemental oxygen in survivors at 36 weeks only) Show forest plot

9

620

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.53, 0.87]

21.1 Strict studies

4

218

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.52, 1.07]

21.2 Hybrid studies

5

402

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.46, 0.89]
Figuras y tablas -
Comparison 1. Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ subgroup by mode of ventilation
Ir a la tabla de la revisión
Comparison 2. Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death in hospital Show forest plot

5

246

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.42, 1.21]

1.1 Strict studies

4

226

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.46, 1.39]

1.2 Hybrid studies

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 1.86]

2 Death or bronchopulmonary dysplasia (BPD) (36 weeks) Show forest plot

4

224

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.62, 1.01]

2.1 Strict studies

3

81

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.52, 1.10]

2.2 Hybrid studies

1

143

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.59, 1.12]

3 Duration of positive pressure ventilation (days, survivors) Show forest plot

5

198

Mean Difference (IV, Fixed, 95% CI)

‐0.82 [‐4.43, 2.80]

3.1 Strict studies

3

63

Mean Difference (IV, Fixed, 95% CI)

‐0.32 [‐4.53, 3.89]

3.2 Hybrid studies

2

135

Mean Difference (IV, Fixed, 95% CI)

‐2.21 [‐9.29, 4.87]

4 Duration of positive pressure ventilation (log data, survivors) Show forest plot

5

198

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.12, 0.10]

4.1 Strict studies

3

63

Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.23, 0.14]

4.2 Hybrid studies

2

135

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.12, 0.14]

5 Any pH < 7.25 Show forest plot

2

46

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.46, 1.09]

6 Hypocarbia partial pressure of carbon dioxide (pCO2) < 35 mmHg/4.7 kPa Show forest plot

1

6

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 2.36]

7 Respiratory acidosis pH < 7.25 and pCO2 > 60 mmHg/8 kPa Show forest plot

2

46

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.43, 1.47]

8 Hypocarbia or respiratory acidosis Show forest plot

1

6

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 2.36]

9 Patent ductus arteriosus Show forest plot

4

241

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.85, 1.39]

9.1 Strict studies

2

75

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.77, 1.57]

9.2 Hybrid studies

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.78, 1.50]

10 Air leak (any) Show forest plot

4

189

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.55, 2.23]

10.1 Strict studies

2

23

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.10, 7.24]

10.2 Hybrid studies

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.54, 2.40]

11 Pneumothorax Show forest plot

5

247

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.29, 1.37]

11.1 Strict studies

3

81

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.11, 1.90]

11.2 Hybrid studies

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.28, 1.86]

12 Pulmonary interstitial emphysema Show forest plot

4

189

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.58, 3.67]

12.1 Strict studies

2

23

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.10, 7.24]

12.2 Hybrid studies

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

1.62 [0.58, 4.53]

13 Any intraventricular haemorrhage (IVH) Show forest plot

4

225

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.55, 1.16]

13.1 Strict studies

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.62, 2.08]

13.2 Hybrid studies

2

163

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.40, 1.06]

14 IVH grade 3‐4 Show forest plot

4

184

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.27, 1.04]

14.1 Strict studies

3

164

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.28, 1.36]

14.2 Hybrid studies

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.09, 1.27]

15 Periventricular leukomalacia (PVL) Show forest plot

4

203

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.15, 1.24]

15.1 Strict studies

3

79

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.10, 1.53]

15.2 Hybrid studies

1

124

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.10, 2.63]

16 Any IVH or PVL Show forest plot

3

186

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.60, 1.35]

16.1 Strict studies

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.61, 1.80]

16.2 Hybrid studies

1

124

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.43, 1.42]

17 IVH grade 3‐4 or PVL Show forest plot

3

145

Odds Ratio (M‐H, Fixed, 95% CI)

0.39 [0.15, 0.99]

17.1 Strict studies

2

21

Odds Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 1.04]

17.2 Hybrid studies

1

124

Odds Ratio (M‐H, Fixed, 95% CI)

0.56 [0.19, 1.64]

18 BPD (supplemental oxygen in survivors at 36 weeks) Show forest plot

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.12]

18.1 Strict studies

3

79

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.49, 1.50]

18.2 Hybrid studies

1

123

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.53, 1.18]
Figuras y tablas -
Comparison 2. Volume‐targeted ventilation (VTV) versus pressure‐limited ventilation (PLV) ‐ infants weighing less than 1000 g
Ir a la tabla de la revisión
Comparison 3. Miscellaneous post hoc analyses

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe disability (any definition) Show forest plot

2

209

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.47, 1.59]

2 Severe disability (any definition) or death Show forest plot

1

109

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.27, 1.06]

3 Gross motor developmental issue (any definition) Show forest plot

1

128

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.47, 2.14]

4 Steroids for bronchopulmonary dysplasia Show forest plot

1

203

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.65, 1.31]

5 Need for home oxygen (survivors) Show forest plot

2

270

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.30, 1.36]

6 Need for home oxygen (survivors weighing < 1000 g) Show forest plot

1

123

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.25, 2.23]
Figuras y tablas -
Comparison 3. Miscellaneous post hoc analyses
Ir a la tabla de la revisión