Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children

Prakeshkumar S Shah; Arne Ohlsson; Jyotsna P Shah

doi:10.1002/14651858.CD003699.pub4

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Figure 1

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

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Figure 2

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

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Comparison 1 Oxygen requirement, Outcome 1 Less than 30% FiO2 after one hour of therapy.

Analysis 1.1

Comparison 1 Oxygen requirement, Outcome 1 Less than 30% FiO₂ after one hour of therapy.

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Analysis 2.1

Comparison 2 Need for assisted ventilation (intermittent positive pressure ventilation or CPAP), Outcome 1 Intermittent positive pressure ventilation during hospital stay.

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Analysis 2.2

Comparison 2 Need for assisted ventilation (intermittent positive pressure ventilation or CPAP), Outcome 2 CPAP during hospital stay.

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Summary of findings for the main comparison. Continuous negative extrathoracic pressure ventilation compared with control for acute hypoxaemic respiratory failure in children

Continuous negative extrathoracic pressure ventilation compared with control for acute hypoxaemic respiratory failure in children
Patient or population: children with acute hypoxaemic respiratory failure Settings: hospital Intervention: continuous negative extrathoracic pressure Comparison: control
Outcomes	Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)
Less than 30% FiO₂ after 1 hour of therapy	RR 10.69 (0.62 to 183.85)	33 (1)	⊕⊝⊝⊝ very low ^1,2
Intermittent positive pressure ventilation during hospital stay	RR 0.40 (0.02 to 9.06)	33 (1)	⊕⊝⊝⊝ very low ^1,3
CPAP during hospital stay	RR 0.40 (0.02 to 9.06)	33 (1)	⊕⊝⊝⊝ very low ^1,3
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
CPAP = continuous positive extrathoracic pressure FiO₂ = fraction of inspired oxygen RR = randomised controlled trial ¹ = Very wide confidence intervals ²= The outcome is only reported after one hour of treatment which is a very short period for any clinically meaningful assessment ³= Limitation in study design as the results are reported in an abstract and it was not possible to assess the study adequately (see assessment of risk of biases)

Summary of findings for the main comparison. Continuous negative extrathoracic pressure ventilation compared with control for acute hypoxaemic respiratory failure in children

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Comparison 1. Oxygen requirement

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Less than 30% FiO₂ after one hour of therapy Show forest plot	1	33	Risk Ratio (M‐H, Fixed, 95% CI)	10.69 [0.62, 183.85]

Comparison 1. Oxygen requirement

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Comparison 2. Need for assisted ventilation (intermittent positive pressure ventilation or CPAP)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Intermittent positive pressure ventilation during hospital stay Show forest plot	1	33	Risk Ratio (M‐H, Fixed, 95% CI)	0.40 [0.02, 9.06]

2 CPAP during hospital stay Show forest plot	1	33	Risk Ratio (M‐H, Fixed, 95% CI)	0.40 [0.02, 9.06]

Comparison 2. Need for assisted ventilation (intermittent positive pressure ventilation or CPAP)

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