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Synchronized mechanical ventilation for respiratory support in newborn infants

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Authors

Anne Greenough1, Thomas E Rossor1, Adesh Sundaresan1, Vadivelam Murthy1, Anthony D Milner1

Background - Methods - Results - Characteristics of Included Studies - References - Data Tables & Graphs


1Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King’s College London, London, UK [top]

Citation example: Greenough A, Rossor TE, Sundaresan A, Murthy V, Milner AD. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD000456. DOI: 10.1002/14651858.CD000456.pub5.

Contact person

Anne Greenough

Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma
King’s College London
Bessemer Road
London
UK

E-mail: anne.greenough@kcl.ac.uk

Dates

Assessed as Up-to-date: 05 June 2016
Date of Search: 05 June 2016
Next Stage Expected: 05 June 2018
Protocol First Published: Issue 1, 1998
Review First Published: Issue 1, 1998
Last Citation Issue: Issue 9, 2016

What's new

Date / Event Description
22 August 2016
Amended

Author order corrected

22 September 2015
New citation: conclusions changed

Conclusions updated.

24 July 2015
Updated

Seven additional studies incorporated, with new comparisons.

History

Date / Event Description
21 May 2012
New citation: conclusions not changed

One additional study was identified as eligible for inclusion and additional studies were designated as "excluded studies".

21 May 2012
Updated

This review updates the existing review of "Synchronized mechanical ventilation for respiratory support in newborn infants" published in The Cochrane Library, Issue 4, 2008 (Greenough 2008).

31 August 2007
New citation: conclusions changed

Substantive amendment

31 August 2007
Updated

This review updates the existing review of "Synchronized mechanical ventilation for respiratory support in newborn infants" published in The Cochrane Library, Issue 3, 2004 (Greenough 2004).

Two additional studies were identified as eligible for inclusion and additional studies were designated as "excluded studies". Two further triggered modes are included: pressure support and pressure regulated volume control ventilation have been included.

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Abstract

Background

During synchronised mechanical ventilation, positive airway pressure and spontaneous inspiration coincide. If synchronous ventilation is provoked, adequate gas exchange should be achieved at lower peak airway pressures, potentially reducing baro/volutrauma, air leak and bronchopulmonary dysplasia. Synchronous ventilation can potentially be achieved by manipulation of rate and inspiratory time during conventional ventilation and employment of patient-triggered ventilation.

Objectives

To compare the efficacy of:

(i) synchronised mechanical ventilation, delivered as high-frequency positive pressure ventilation (HFPPV) or patient-triggered ventilation (assist control ventilation (ACV) and synchronous intermittent mandatory ventilation (SIMV)), with conventional ventilation or high-frequency oscillation (HFO);

(ii) different types of triggered ventilation (ACV, SIMV, pressure-regulated volume control ventilation (PRVCV), SIMV with pressure support (PS) and pressure support ventilation (PSV)).

Search methods

We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 5), MEDLINE via PubMed (1966 to June 5 2016), EMBASE (1980 to June 5 2016), and CINAHL (1982 to June 5 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.

Selection criteria

Randomised or quasi-randomised clinical trials comparing synchronised ventilation delivered as HFPPV to CMV, or ACV/SIMV to CMV or HFO in neonates. Randomised trials comparing different triggered ventilation modes (ACV, SIMV, SIMV plus PS, PRVCV and PSV) in neonates.

Data collection and analysis

Data were collected regarding clinical outcomes including mortality, air leaks (pneumothorax or pulmonary interstitial emphysema (PIE)), severe intraventricular haemorrhage (grades 3 and 4), bronchopulmonary dysplasia (BPD) (oxygen dependency beyond 28 days), moderate/severe BPD (oxygen/respiratory support dependency beyond 36 weeks' postmenstrual age (PMA) and duration of weaning/ventilation.

Eight comparisons were made: (i) HFPPV versus CMV; (ii) ACV/SIMV versus CMV; (iii) SIMV or SIMV + PS versus HFO; iv) ACV versus SIMV; (v) SIMV plus PS versus SIMV; vi) SIMV versus PRVCV; vii) SIMV vs PSV; viii) ACV versus PSV. Data analysis was conducted using relative risk for categorical outcomes, mean difference for outcomes measured on a continuous scale.

Main results

Twenty-two studies are included in this review. The meta-analysis demonstrates that HFPPV compared to CMV was associated with a reduction in the risk of air leak (typical relative risk (RR) for pneumothorax was 0.69, 95% confidence interval (CI) 0.51 to 0.93). ACV/SIMV compared to CMV was associated with a shorter duration of ventilation (mean difference (MD) −38.3 hours, 95% CI −53.90 to −22.69). SIMV or SIMV + PS was associated with a greater risk of moderate/severe BPD compared to HFO (RR 1.33, 95% CI 1.07 to 1.65) and a longer duration of mechanical ventilation compared to HFO (MD 1.89 days, 95% CI 1.04 to 2.74).

ACV compared to SIMV was associated with a trend to a shorter duration of weaning (MD −42.38 hours, 95% CI −94.35 to 9.60). Neither HFPPV nor triggered ventilation was associated with a significant reduction in the incidence of BPD. There was a non-significant trend towards a lower mortality rate using HFPPV versus CMV and a non-significant trend towards a higher mortality rate using triggered ventilation versus CMV. No disadvantage of HFPPV or triggered ventilation was noted regarding other outcomes.

Authors' conclusions

Compared to conventional ventilation, benefit is demonstrated for both HFPPV and triggered ventilation with regard to a reduction in air leak and a shorter duration of ventilation, respectively. In none of the trials was complex respiratory monitoring undertaken and thus it is not possible to conclude that the mechanism of producing those benefits is by provocation of synchronised ventilation. Triggered ventilation in the form of SIMV ± PS resulted in a greater risk of BPD and duration of ventilation compared to HFO. Optimisation of trigger and ventilator design with respect to respiratory diagnosis is encouraged before embarking on further trials. It is essential that newer forms of triggered ventilation are tested in randomised trials that are adequately powered to assess long-term outcomes before they are incorporated into routine clinical practice.

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Plain language summary

Synchronised mechanical ventilation for respiratory support in newborn infants

 

The majority of newborn babies in need of mechanical assistance to support them also breathe to some degree. If the baby's attempts to breathe are synchronised with the mechanical breaths from the ventilator, less pressure may be needed. This could reduce the chance of air leak or variations in blood flow to the brain. The review of trials found, when compared to conventional mechanical ventilation (CMV), high-frequency positive pressure ventilation (HFPPV) reduced the risk of air leak and triggered ventilation was associated with a shorter duration of ventilation. Compared to high-frequency oscillation, however, certain triggered modes of ventilation resulted in a greater risk of moderate to severe chronic lung disease and a longer duration of ventilation. Newer forms of triggered ventilation have only been evaluated in small randomised trials and have not been demonstrated to have advantages in important clinical outcomes.

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Background

Description of the condition

The majority of neonates breathe during mechanical ventilation. Those that actively exhale against positive pressure inflation develop pneumothoraces; whereas if positive pressure inflation and spontaneous inspiration coincide (synchrony), oxygenation and carbon dioxide elimination improve. If synchrony occurs, it should be possible to achieve adequate gas exchange at lower inflating pressures, reducing barotrauma, a known risk factor for bronchopulmonary dysplasia. Active expiration is more common if infants have non-compliant lungs and are ventilated with long inspiratory times or relatively slow ventilator rates (30 to 40 bpm), or both. Increasing ventilator rate and reducing inspiratory time, mimicking more closely the preterm infant's respiratory pattern, has been shown in a proportion of infants to stop them actively expiring.

Description of the intervention

Synchronised ventilation can be achieved by HFPPV during which the ventilator rate more closely resembles the spontaneous respiratory rate of very prematurely born infants, and this is more likely to be associated with synchronous ventilation. It can also be achieved by PTV (ACV, SIMV, PRVCV or PSV), during which the infant's respiratory efforts exceeding a critical level trigger a positive pressure inflation. In SIMV only a preset number of the infant's respiratory efforts trigger positive pressure inflations.

How the intervention might work

During mechanical ventilation, infants actively exhale against positive pressure inflation and develop pneumothoraces. Theoretically, by increasing synchronous ventilation, either HFPPV or PTV could reduce air leaks and associated intraventricular haemorrhage and BPD. Indeed, 'triggered ventilation' compared to conventional mechanical ventilation (CMV) has been shown to improve tidal volume (Jarreau 1996) and oxygenation (Cleary 1995) and reduce blood pressure fluctuations (Hummler 1996). Synchronised mechanical ventilation might also reduce baro trauma and hence BPD.

Why it is important to do this review

The aim of this review was to determine whether HFPPV or triggered ventilation were associated with positive outcomes for prematurely born neonates. This review updates the existing review of synchronised ventilation which was published in the Cochrane Database of Systematic Reviews Issue 1, 2008 (Greenough 2008).

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Objectives

To compare the efficacy of:

  1. synchronised mechanical ventilation, delivered as high-frequency positive pressure ventilation (HFPPV) or patient-triggered ventilation (assist control ventilation (ACV) and synchronous intermittent mandatory ventilation (SIMV)), with conventional ventilation or high-frequency oscillation (HFO);
  2. different types of triggered ventilation (ACV, SIMV, pressure-regulated volume control ventilation (PRVCV), SIMV with pressure support (PS) and pressure support ventilation (PSV))

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Methods

Criteria for considering studies for this review

Types of studies

Randomised or quasi-randomised clinical trials comparing the use of synchronised ventilation (HFPPV or patient-triggered ventilation) to conventional ventilation or high-frequency oscillation, and randomised trials of different modes of triggered ventilation in neonates were considered for this review.

Types of participants

Neonates (less than four weeks of age) requiring assisted ventilation.

Types of interventions

We considered two forms of ventilation likely to induce synchrony:

high-frequency positive pressure ventilation (HFPPV, ventilator rates greater than/or equal to 60 bpm); and triggered ventilation.

Triggered ventilation was divided into:

  • assist control ventilation (ACV), otherwise known as synchronous intermittent positive pressure ventilation (SIPPV), the infant being able to trigger a positive pressure inflation with each breath;
  • synchronised intermittent mandatory ventilation (SIMV), the infant being able to trigger only a pre-set number of positive pressure inflations;
  • pressure-regulated volume control ventilation (PRVCV), a synchronised pressure-limited assist control mode that sequentially varies the delivered pressure to approximate a target inspiratory tidal volume;
  • pressure support ventilation, the initiation and end of inflation triggered by the infant's respiratory effort;
  • SIMV with pressure support (PS); PS assists every additional spontaneous breath beyond the set SIMV rate.

These modes of ventilation were compared to non-synchronised ventilation either in the form of conventional ventilation (CMV), which for the purpose of this review is defined as pressure pre-set, time-limited ventilation delivered at rates of fewer than 60 bpm, or high-frequency oscillatory ventilation (HFO).

Infants were randomly allocated to receive one or other forms of ventilation (except in Heicher 1981 when alternate allocation was used):

  • HFPPV versus CMV;
  • ACV or SIMV versus CMV;
  • SIMV or SIMV + PS versus HFO.

Triggered modes of ventilation were compared:

  • ACV versus SIMV;
  • SIMV plus PS versus SIMV;
  • SIMV versus PRVCV;
  • SIMV versus PSV;
  • ACV versus PSV.

Types of outcome measures

Primary outcomes

Data regarding clinical outcomes included:

  • mortality;
  • air leaks (pneumothorax or pulmonary interstitial emphysema (PIE));
  • severe intraventricular haemorrhage (grades 3 and 4);
  • bronchopulmonary dysplasia (BPD) (oxygen dependency beyond 28 days);
  • moderate/severe BPD (oxygen dependency or respiratory support dependency (or both) at 36 weeks' postmenstrual age);
  • duration of weaning/ventilation.

Search methods for identification of studies

Electronic searches

For the 2016 update we used the criteria and standard methods of Cochrane and the Cochrane Neonatal Review Group (see the Cochrane Neonatal Group search strategy for specialized register External Web Site Policy).

We conducted a comprehensive search including: the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 5) in The Cochrane Library; MEDLINE via PubMed (1996 to June 5 2016); EMBASE (1980 to June 5 2016); and CINAHL (1982 to June 5 2016) using the following search terms: (mechanical ventilation[MeSH] OR respiration, artificial[MeSH] OR mechanical ventilation OR triggered ventilation OR SIMV), plus database-specific limiters for RCTs and neonates (see Appendix 1 for the full search strategies for each database). We did not apply language restrictions.

We searched clinical trials registries for ongoing or recently completed trials (clinicaltrials.gov; the World Health Organization’s International Trials Registry and Platform www.who.int/ictrp/search/en/ External Web Site Policy; and the ISRCTN Registry External Web Site Policy).

For the previous version of this review we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2008); Oxford Database of Perinatal Trials; MEDLINE from 1966 to 2008; and EMBASE 1996 to 2008 (MeSH terms: mechanical ventilation; triggered ventilation; artificial respiration; newborn infant).

Searching other resources

We searched previous reviews, abstracts, symposia proceedings as well as conducting handsearches of journals in the English language and establishing contact with expert informants.

Data collection and analysis

Three of the review authors (AS, TR, VM) identified trials that might be included. Each trial was then assessed independently by each review author who completed data collection forms that the review authors had previously agreed upon. The results were then compared and if there was disagreement a fourth and fifth review author (AG, ADM) assessed the results independently. For each included trial, we collected information regarding the method of randomisation, blinding, stratification, number of centres participating in the study, trial inclusion and exclusion criteria and sample size. We also collected demographic data of the trial participants (e.g. gestational age, birth weight, postnatal age, primary diagnosis). We analysed information on clinical outcomes including death, air leaks, intraventricular haemorrhage, chronic lung disease, duration of ventilation or weaning, ventilation mode failure and extubation failure. The denominator for each outcome was the number randomised. In the meta-analyses involving comparison with CMV or HFO, either HFPPV or ACV/SIMV was designated the experimental therapy. In the meta-analyses of ACV or PRVCV versus SIMV, then ACV or PRVCV was designated the experimental therapy. In the meta-analyses of SIMV with PS versus SIMV, SIMV with PS was designated the experimental therapy, and in the meta-analysis of ACV versus PSV, ACV was designated the experimental therapy.

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Main results

Description of studies

Included studies

We identified twenty-two studies for inclusion in this review (see Figure 1).

1. HFPPV versus CMV (Heicher 1981; OCTAVE 1991; Pohlandt 1992; Amini 2013).

2. ACV/SIMV versus CMV: Chan 1993 (ACV versus CMV); Donn 1994 (SIMV versus CMV); Bernstein 1996 (SIMV versus CMV); Chen 1997 (SIMV versus CMV); Baumer 2000 (ACV versus CMV); Beresford 2000 (ACV versus CMV); Liu 2011 (ACV versus CMV).

3. SIMV or SIMV + PS versus HFO (Courtney 2002a; Craft 2003a; Singh 2012; Sun 2014)

4. ACV versus SIMV (Chan 1994; Dimitriou 1995a; Dimitriou 1995b)

5. SIMV plus PS versus SIMV (Reyes 2006)

6. SIMV versus PRVCV (D'Angio 2005)

7. SIMV versus PSV (Erdemir 2014)

8. ACV versus PSV (Patel 2012)

Pohlandt 1992, Chan 1993, Chan 1994, Dimitriou 1995a, Dimitriou 1995b, Baumer 2000 and Beresford 2000 included only preterm infants. Donn 1994 included preterm infants with a birth weight between 1100 grams and 1500 grams. Courtney 2002a included infants with a birth weight between 601 grams and 1200 grams. Reyes 2006 included preterm infants with a birth weight of 500 grams to 1000 grams. Singh 2012 included infants with a birth weight of greater than 750 grams. D'Angio 2005 included preterm infants with a birth weight of 500 grams to 1249 grams. Erdemir 2014 and Sun 2014 included preterm infants with birth weight less than 1500 grams. Craft 2003a included preterm infants with birth weight less than 1000 grams. Bernstein 1996, Heicher 1981 and OCTAVE 1991 studied mainly premature neonates. Chen 1997 included term and preterm infants but analysed the groups separately; only the results from the 63 infants with RDS are included in the meta-analysis. Amini 2013 does not make it clear whether term as well as preterm infants were included. Patel 2012 included infants of any gestation who were less than 14 days old.

Information regarding use of antenatal steroids was given only in Baumer 2000, Beresford 2000, Courtney 2002a, Craft 2003a, D'Angio 2005, Reyes 2006, Patel 2012, Singh 2012, Erdemir 2014 and Sun 2014. Data regarding surfactant usage were available in the trials of Donn 1994, Chan 1994, Dimitriou 1995a, Dimitriou 1995b, Bernstein 1996, Chen 1997, Baumer 2000, Beresford 2000, Courtney 2002a, Craft 2003a, D'Angio 2005, Reyes 2006, Patel 2012, Singh 2012, Amini 2013, Erdemir 2014 and Sun 2014. The age at entry varied between studies; the trials of Chan 1993, Chan 1994, Dimitriou 1995a, Dimitriou 1995b, Reyes 2006, Patel 2012 and Erdemir 2014 were weaning studies. Data for the duration of ventilation or weaning were obtained by personal communication with the investigators for Chan 1993, Chan 1994, Dimitriou 1995a, Dimitriou 1995b, Baumer 2000 and Beresford 2000.

Excluded studies

Seventy-two additional studies were detected, but were found to be not eligible for inclusion in this review (see table Characteristics of excluded studies).

Risk of bias in included studies

All the studies but one were randomised; Heicher 1981 used alternate allocation. The method of randomisation is reported in all but one trial (Chen 1997). Certain outcomes were only available in some of the trials and therefore only presented for the subgroups in which they were reported for at least two trials, except for the trials assessing PSV, PRVCV and SIMV plus PS.

HFPPV versus CMV: In Heicher 1981 and OCTAVE 1991 analysis was by intention to treat, but in Pohlandt 1992 infants not ventilated strictly according to the technique to which they were randomised were excluded from the analysis.

SIMV/ACV versus CMV: Analysis was according to intention to treat in Chan 1993 and Baumer 2000; in Bernstein 1996, 6% of infants erroneously randomised because of problems including seizures, non-viability and birth weight of less than 500 grams were excluded from the analysis.

SIMV or SIMV + PS versus HFO: Analysis was according to intention to treat in Courtney 2002a and Sun 2014. In Craft 2003a an ad-hoc interim analysis was performed due to declining recruitment and the study was curtailed.

ACV versus SIMV: Dimitriou 1995 is presented as two studies (Dimitriou 1995a; Dimitriou 1995b), as two separate consecutive randomised trials were performed in which ACV was compared to two different methods of delivering SIMV. In Chan 1994, Dimitriou 1995a and Dimitriou 1995b weaning failure was defined as no reduction in ventilator settings over a 24 or 48 hour period respectively; extubation failure was defined as a requirement for re-intubation using standardised criteria within a 48 hour period.

SIMV plus PS versus SIMV: In Reyes 2006 analysis was by intention to treat; five infants who were randomised met exclusion criteria and their results were not included in the analysis.

PRVCV versus SIMV: In D'Angio 2005 analysis was by intention to treat; one infant did not receive the allocated intervention.

SIMV vs PSV: In Erdemir 2014 weaning and extubation was performed according to standardised criteria. Analysis was not stated to be by intention to treat; however there were no failures of weaning reported in either arm.

ACV vs PSV: In Patel 2012 analysis was by intention to treat. Weaning was by standardised criteria.

Effects of interventions

HFPPV versus CMV (comparison 1)

Death (Analysis 1.1): Four trials reported this outcome (Heicher 1981; OCTAVE 1991; Pohlandt 1992; Amini 2013). None demonstrated a significant effect. The meta-analysis indicates a trend towards reduction in death rate using HFPPV but this does not reach statistical significance (relative risk (RR) 0.78, 95% confidence interval (CI) 0.61 to 1.00).

Air leaks (Analysis 1.2 and Analysis 1.3): Three trials reported pneumothorax as an outcome (Heicher 1981; OCTAVE 1991; Pohlandt 1992); one trial reported a significant effect, with a lower rate of pneumothorax in the HFPPV group (Heicher 1981). The meta-analysis supports a significant reduction in the risk of pneumothorax (typical RR for pneumothorax was 0.69, 95% CI 0.51 to 0.93). Pohlandt 1992 reported a significant reduction in PIE in the HFPPV group (RR 0.68, 95% CI 0.49 to 0.94). Amini 2013 reported total air leaks as outcome variable, with a non-significant trend favouring HFPPV (RR 0.25, 95% CI 0.06 to 1.08).

BPD (oxygen dependency at 28 days) (Analysis 1.4): Four trials reported this outcome (Heicher 1981; OCTAVE 1991; Pohlandt 1992; Amini 2013). None demonstrated a significant effect. The meta-analysis found no evidence of effect.

IVH (Analysis 1.5): One trial reported this outcome, with a significantly lower rate of IVH in the HFPPV group (RR 0.13, 95% CI 0.02 to 0.94) (Amini 2013).

Other outcomes: The incidence of PDA post randomisation was given in two trials (Heicher 1981; Pohlandt 1992); in neither did it differ significantly.

ACV/SIMV versus CMV (comparison 2)

Death (Analysis 2.1): Six trials reported this outcome (Donn 1994; Bernstein 1996; Chen 1997; Baumer 2000; Beresford 2000; Liu 2011). None demonstrated a significant effect. The meta-analysis indicates a trend towards an increase in death rate using ACV/SIMV but this does not reach statistical significance (typical RR 1.17, 95% CI 0.94 to 1.47).

Air leaks (Analysis 2.2): Seven trials reported this outcome (Chan 1993; Donn 1994; Bernstein 1996; Chen 1997; Baumer 2000; Beresford 2000; Liu 2011). None demonstrated a significant effect. The meta-analysis found no evidence of effect.

Duration of ventilation (hours) (Analysis 2.3): Five trials reported this outcome (Donn 1994; Chen 1997; Baumer 2000; Beresford 2000; Liu 2011). Bernstein 1996 also reported the duration of ventilation, but the data are presented as the median and 95% CIs (SIMV 103 hours, 95% CI 94 to 118 versus CMV 120 hours, 95% CI 101 to 142), and the results, therefore, could not be meta-analysed in the relevant Outcome (2.3). A significantly shorter duration of ventilation was noted in Chen's study (Chen 1997) and Donn's study (Donn 1994). The meta-analysis of the five studies supported a significant reduction in ventilation duration (MD −38.30 hours, 95% CI −53.90 to −22.69). Chan 1993 reported the duration of weaning: ACV mean 39 hours, SD 45 versus CMV mean 65 hours, SD 75 (the results are not presented in Outcome 2.3).

Extubation failure (Analysis 2.4): Four trials reported this outcome (Chan 1993; Donn 1994; Chen 1997; Baumer 2000). One trial reported a significant effect in favour of ACV/SIMV (Chen 1997). The meta-analysis of the results of the four trials, however, did not demonstrate a significant effect, the typical RR being 0.93 (95% CI 0.68 to 1.28).

Severe IVH (Analysis 2.5): Six trials reported this outcome (Donn 1994; Bernstein 1996; Chen 1997; Baumer 2000; Beresford 2000; Liu 2011). None demonstrated a significant effect. The meta-analysis found no evidence of effect.

BPD (oxygen dependency at 28 days) (Analysis 2.6): Four trials reported this outcome (Baumer 2000; Bernstein 1996; Chen 1997; Donn 1994). None demonstrated a significant effect. The meta-analysis found no evidence of effect.

Moderate/severe BPD (Oxygen dependency at 36 weeks postmenstrual age) (Analysis 2.7): Two trials reported this outcome (Baumer 2000; Beresford 2000). Neither demonstrated a significant effect. The meta-analysis found no evidence of effect.

Other outcomes: In two trials the incidence of PDA is given post randomisation (Chen 1997; Beresford 2000). In one trial only the incidence of PDA requiring indomethacin and/or ligation was higher in the conventional group for both survivors (P < 0.05) and the whole population of infants (P < 0.05) (Beresford 2000).

SIMV OR SIMV + PS versus HFO (comparison 3)

Death (Analysis 3.1): Four trials of SIMV OR SIMV + PS VS HFO reported this outcome (Courtney 2002a; Craft 2003a; Singh 2012; Sun 2014). Sun 2014 reported a significant effect in favour of HFO (RR 3.21, 95% CI 1.07 to 9.67). No other trials reported a difference in this outcome, and the meta-analysis found no evidence of effect.

BPD: oxygen dependency at 28 days (Analysis 3.2): One trial reported this outcome with no significant effect (Singh 2012).

Moderate/Severe BPD (Analysis 3.3): Three trials reported this outcome (Courtney 2002a; Craft 2003a; Sun 2014). Sun 2014 reported a significant effect in favour of HFO (RR 2.24, 95% CI 1.20 to 4.18) and Courtney 2002a reported a trend in favour of HFO (RR 1.24, 95% CI 0.96 to 1.60). The meta-analysis showed a significant effect in favour of HFO (RR 1.33, 95% CI 1.07 to 1.65).

Death or BPD (Analysis 3.4): Only one study reported this combined outcome, with a significant effect in favour of HFO (RR 2.38, 95% CI 1.41 to 4.03) (Sun 2014).

Duration of mechanical ventilation (Analysis 3.5): Two trials reported this outcome with both showing a significant effect in favour of HFO (Singh 2012; Sun 2014). The meta-analysis demonstrated a significant effect in favour of HFO (Mean difference 1.89 days, 95% CI 1.04 to 2.74).

Air Leaks (Analysis 3.6): One trial reported PIE as an outcome and showed a significant decrease of this outcome in the SIMV group (RR 0.66, CI 0.44 to 0.99) (Courtney 2002a). Three trials reported pneumothorax as an outcome with no significant difference (Courtney 2002a; Craft 2003a; Sun 2014).

IVH Grade 3 or 4 (Analysis 3.7): Four trials reported this outcome (Courtney 2002a; Craft 2003a; Singh 2012; Sun 2014). No trial found a significant difference.

ACV versus SIMV (comparison 4)

Duration of weaning (hours) (Analysis 4.1): Three trials of ACV versus SIMV reported this outcome (Chan 1994; Dimitriou 1995a; Dimitriou 1995b). None demonstrated a significant effect. In all three, however, the duration of weaning tended to be shorter in infants supported by ACV rather than SIMV. The meta-analysis supported a trend in this direction which, however, did not reach statistical significance.

Weaning failure (Analysis 4.2): Three trials of ACV versus SIMV reported this outcome (Chan 1994; Dimitriou 1995a; Dimitriou 1995b). None demonstrated a significant effect. The meta-analysis found no evidence of effect.

Extubation failure (Analysis 4.3): Three trials of ACV versus SIMV (Chan 1994; Dimitriou 1995a; Dimitriou 1995b) reported this outcome. None demonstrated a significant effect. The meta-analysis found no evidence of effect.

Air leaks (Analysis 4.4): Three trials of ACV versus SIMV (Chan 1994; Dimitriou 1995a; Dimitriou 1995b) reported this outcome. None demonstrated a significant effect. The meta-analysis found no evidence of effect.

SIMV PLUS PS versus SIMV (comparison 5)

Only Reyes 2006 reports on SIMV plus PS compared to SIMV alone.

Death (Analysis 5.1): There was no significant effect with regard to death at 28 days or death prior to discharge.

Air leaks (Analysis 5.2): The occurrence of PIE and pneumothorax are reported separately; there were no significant differences in either outcome.

BPD, oxygen dependency at 28 days (Outcome 5.3.1): There was no significant effect.

Moderate/severe BPD, oxygen dependency at 36 weeks postmenstrual age (Outcome 5.3.2): There was no overall significant effect.

Severe IVH (Grade III and IV) (Analysis 5.4): There was no significant effect.

Other outcomes: There was no significant effect re PDA. Days on mechanical ventilation and supplementary oxygen did not differ by ventilation status, but in the subgroup of infants with birth weight of 700 grams to 1000 grams, the days of supplementary oxygen were lower in the SIMV plus PS group (P = 0.034).

PRVCV versus SIMV (comparison 6)

Death prior to discharge (Analysis 6.1): One trial (D'Angio 2005) reported this with no significant difference between intervention.

BPD, oxygen requirement at 36 weeks' postmenstrual age in survivors (Analysis 6.2): One trial reported this with no significant difference between intervention (D'Angio 2005).

Airleak (PIE (Outcome 6.3.1) or Pneumothorax (Outcome 6.3.2)): In the PRVCV versus SIMV trial there were no significant effects with regard to either pneumothorax or PIE (D'Angio 2005).

Severe IVH (Analysis 6.4): One trial reported this outcome with no significant difference between intervention (D'Angio 2005).

SIMV versus PSV (comparison 7)

Duration of weaning (Analysis 7.1): One trial reported this outcome (Erdemir 2014). There was no significant difference.

Extubation failure (Analysis 7.2): One trial reported this outcome (Erdemir 2014). There was no significant difference.

Air leaks (total) (Analysis 7.3): One trial reported this outcome (Erdemir 2014). There was no significant difference.

Moderate/Severe BPD; Oxygen requirement at 36 weeks postmenstrual age (Analysis 7.4): One trial reported this outcome (Erdemir 2014). There was no significant difference.

ACV versus PSV (comparison 8)

Duration of weaning (Outcome 8.1): One trial reported this outcome (Patel 2012). The data were reported as median and range. No significant difference was reported.

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Discussion

Physiological studies have demonstrated in prematurely born neonates that both high-frequency positive pressure ventilation and triggered ventilation are more likely to provoke a synchronous respiratory interaction; that is, the infant's inspiratory efforts coincide with positive pressure inflations. When compared to CMV, those ventilation modes were shown to be associated with improved ventilation. Unfortunately, in none of the subsequent randomised trials is it reported whether synchronous ventilation was achieved and few outcome measures are consistently reported in all relevant trials. Nevertheless, the meta-analyses demonstrate a significant decrease in air leak and a shorter duration of ventilation with HFPPV and triggered ventilation respectively. However, no significant effect on the incidence of BPD or death has been shown using either HFPPV or trigger ventilation modes.

No deleterious effects of those two ventilatory modes were highlighted. Some positive effects have been demonstrated of the newer triggered modes PRVCV and SIMV plus PS, but both modes have each only been examined in one randomised trial; further trials are required which incorporate long-term outcomes.

A meta-analysis of the studies comparing SIMV or SIMV + PS with HFO show a significant decrease in moderate or severe BPD, and significantly shorter duration of mechanical ventilation with HFO. Whether other trigger modes such as ACV have similar results to HFO requires investigating.

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Authors' conclusions

Implications for practice

Comparative trials of assisted ventilation in neonates demonstrate that, compared to CMV, HFPPV is associated with a reduced risk of air leak and triggered ventilation with a shorter duration of ventilation. On clinical grounds, those ventilatory modes would seem preferable for preterm neonates to 'conventional' ventilation delivered at rates of less than 60 bpm. In addition, HFO resulted in a reduced risk of BPD and duration of ventilation compared to SIMV with or without pressure support. It is important to determine if other triggered modes such as ACV have similar poor results compared to HFO.

Comparative trials demonstrated that in preterm infants in the recovery stage of respiratory distress, ACV compared to SIMV is associated with a shorter duration of ventilation; thus, ACV would seem the more desirable mode of weaning for preterm neonates. There are insufficient randomised trials of PRVCV or pressure support versus SIMV to make any conclusions to their efficacy with regard to long-term efficacy.

Implications for research

Further trials are encouraged to assess whether ventilation modes likely to provoke synchronous ventilation will have other benefits and whether the mechanism of such effects is by provoking synchrony. Optimisation of trigger and ventilator performance with respect to respiratory diagnosis is essential. Randomised trials of the newer triggered modes with long-term outcomes are essential to determining their efficacy.

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Acknowledgements

Dr. Murthy was supported by the Guy's and St Thomas' Charity Fund.

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Contributions of authors

Professor Anne Greenough and Professor Anthony Milner have co-authored all issues of this review.

Dr. Murthy coauthored this 2012 review update.

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Declarations of interest

Professor Anne Greenough and Professor Anthony Milner have held grants and been invited speakers for several of the companies who manufacture/sell ventilators (SLE, Draeger, Bearcub, EME, Sechrist).

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Characteristics of studies

Characteristics of included studies

Amini 2013

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 table
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) High risk

Clinician aware of intervention

Blinding of participants and personnel (performance bias) High risk

No blinding possible

Blinding of outcome assessment (detection bias) High risk

Clinicians likely to be aware of intervention

Incomplete outcome data (attrition bias) Low risk

Complete follow-up of recruited infants

Baumer 2000

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 table
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) 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) 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) High risk

Comment: clinicians likely to be aware of the intervention

Incomplete outcome data (attrition bias) Low risk

Comment: outcome for death (912/924); pneumothorax(922/924); cranial USS (848/924)

Beresford 2000

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 table
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) 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) High risk

Comment: clinicians aware of the intervention

Blinding of outcome assessment (detection bias) High risk

Comment: clinicians aware of the intervention

Incomplete outcome data (attrition bias) Low risk

Comment: complete data present

Bernstein 1996

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 table
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) Low risk

"Intention-to-treat protocol"

Blinding of participants and personnel (performance bias) High risk

Comment: clinicians aware of intervention (intention-to-treat protocol)

Blinding of outcome assessment (detection bias) High risk

"Data were collected prospectively"

Comment: clinicians probably aware of intervention (intention-to-treat protocol)

Incomplete outcome data (attrition bias) Low risk

Comment: outcome for all participants reported

Chan 1993

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 table
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) 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) High risk

Quote:"not possible to "blind" the clinicians"

Comment: different ventilators used for the two study groups

Blinding of outcome assessment (detection bias) High risk

Comment: clinicians aware of intervention

Incomplete outcome data (attrition bias) Low risk

Comment: outcome for all participants reported

Chan 1994

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 table
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) Low risk

"protocol for weaning from ventilation was similar in both groups"

Comment: clinicians aware of intervention

Blinding of participants and personnel (performance bias) High risk

Comment: clinicians aware of the intervention

Blinding of outcome assessment (detection bias) High risk

Comment: clinicians aware of intervention

Incomplete outcome data (attrition bias) Low risk

Comment: outcome for all participants reported

Chen 1997

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 table
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) High risk

Comment: not possible to assess

Blinding of participants and personnel (performance bias) High risk

Comment: not possible to assess

Blinding of outcome assessment (detection bias) Unclear risk

Comment: not possible to assess

Incomplete outcome data (attrition bias) Low risk

Comment: outcome for all participants reported

Courtney 2002a

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 table
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) High risk

No blinding of clinicians: different ventilators used for different arms

Blinding of participants and personnel (performance bias) High risk

No blinding possible as above

Blinding of outcome assessment (detection bias) High risk

Clinicians likely to be aware of intervention

Incomplete outcome data (attrition bias) Unclear risk

10 infants from HFOV and 4 from SIMV withdrawn – data analysed until point of withdrawal

Craft 2003a

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 table
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) High risk

Not possible to blind clinician to treatment arm

Blinding of participants and personnel (performance bias) High risk

Not possible to blind clinician to treatment arm

Blinding of outcome assessment (detection bias) High risk

Assessors likely aware of treatment arm

Incomplete outcome data (attrition bias) High risk

Attrition unclear. Study terminated at ad-hoc interim analysis

D'Angio 2005

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 table
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk  
Allocation concealment (selection bias) Low risk

Quote: "randomly assigned "

Comment: probably done

Blinding (performance bias and detection bias) Low risk

Comment: probably done (Failure and Weaning protocol followed)

Blinding of participants and personnel (performance bias) Unclear risk

Comment: clinicians likely to be aware of the intervention

Blinding of outcome assessment (detection bias) Unclear risk

Comment: clinicians likely to be aware of the intervention

Incomplete outcome data (attrition bias) Low risk

Comment: respiratory outcomes for all participants reported

Dimitriou 1995a

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 table
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) Low risk

Done as protocol followed

Blinding of participants and personnel (performance bias) High risk

Comment: clinicians likely to be aware of the intervention

Blinding of outcome assessment (detection bias) Unclear risk  
Incomplete outcome data (attrition bias) Low risk

Comment: outcome of all trial participants reported.

Dimitriou 1995b

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 table
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) Unclear risk

Done as protocol followed

Blinding of participants and personnel (performance bias) Unclear risk

Comment: clinicians likely to be aware of the intervention

Blinding of outcome assessment (detection bias) Unclear risk  
Incomplete outcome data (attrition bias) Unclear risk

Comment: outcome of all trial participants reported.

Donn 1994

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 table
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) High risk

Comment: not reported

Blinding of participants and personnel (performance bias) High risk

Comment: not possible to assess

Blinding of outcome assessment (detection bias) Unclear risk

Not reported

Incomplete outcome data (attrition bias) Low risk

Comment: outcome of all trial participants reported

Erdemir 2014

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 table
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) High risk

No blinding

Blinding of participants and personnel (performance bias) High risk

No blinding

Blinding of outcome assessment (detection bias) High risk

No blinding

Incomplete outcome data (attrition bias) Low risk

All outcomes reported for all participants

Heicher 1981

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 table
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) Low risk

Quote:"remained constant throughout the study period"

Comment: probably done

Blinding of participants and personnel (performance bias) Unclear risk  
Blinding of outcome assessment (detection bias) High risk

Comment: probably not done

Incomplete outcome data (attrition bias) Low risk

Comment: outcomes reported for all trial participants

Liu 2011

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 less than/or equal to 250 mmHg; a/APO₂ less than/or equal to 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 table
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) High risk

Comment: probably not done

Blinding of participants and personnel (performance bias) High risk

Comment: probably not done

Blinding of outcome assessment (detection bias) High risk

Comment: probably not done

Incomplete outcome data (attrition bias) Low risk

Comment: outcomes of all participants reported.

OCTAVE 1991

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 table
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 (performance bias and detection bias) Unclear risk  
Blinding of participants and personnel (performance bias) High risk

Comment: clinicians probably aware of the intervention

Blinding of outcome assessment (detection bias) High risk

Comment: clinicians probably aware of the intervention

Incomplete outcome data (attrition bias) Low risk

Comment: short-term outcome reported for all participants

Patel 2012

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 less than/or equal to 20 cmH₂O if greater than/or equal to 29 weeks' gestation; less than/or equal to 17 cmH₂O if between 26 and 29 weeks' gestation; or less than/or equal to 15 cmH₂O if less than/or equal to 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 table
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) Low risk

No blinding of clinician. Analysis by intention to treat

Blinding of participants and personnel (performance bias) High risk

No blinding

Blinding of outcome assessment (detection bias) High risk

No blinding

Incomplete outcome data (attrition bias) Low risk

Not all short term outcomes measured at all time points, but relevant outcomes reported for all participants

Pohlandt 1992

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 table
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 (performance bias and detection bias) Unclear risk  
Blinding of participants and personnel (performance bias) High risk

Comment: clinicians probably aware of the intervention

Blinding of outcome assessment (detection bias) High risk

Comment: probably not done

Incomplete outcome data (attrition bias) Low risk

Comment: primary outcomes of all participants reported

Reyes 2006

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 table
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) Low risk

Quote: "study protocol was actively followed"

Comment: probably done

Blinding of participants and personnel (performance bias) High risk

Quote: "Caregivers were not blinded to the assigned modality"

Comment: not followed

Blinding of outcome assessment (detection bias) High risk

Comment: clinicians probably aware of the intervention

Incomplete outcome data (attrition bias) Low risk

Comment: outcomes of all trial participants reported

Singh 2012

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 table
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) High risk

No blinding

Blinding of participants and personnel (performance bias) High risk

No blinding

Blinding of outcome assessment (detection bias) High risk

No blinding

Incomplete outcome data (attrition bias) High risk

HFOV arm 17 died/left study; SIMV 23 died/left study

Sun 2014

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 table
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) High risk

Different ventilators used, no blinding

Blinding of participants and personnel (performance bias) High risk

Different ventilators used, no blinding

Blinding of outcome assessment (detection bias) High risk

Different ventilators used, no blinding

Incomplete outcome data (attrition bias) Unclear risk

High risk for long-term outcomes with approximately 30% lost to follow-up

Low risk for short-term outcomes

Footnotes

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

Abd El-Moneim 2005

Reason for exclusion

Short-term cross over study

Abubakar 2005

Reason for exclusion

Randomised short-term cross over study

Amitay 1993

Reason for exclusion

Not assigned respiratory support mode by randomisation

Bernstein 1993

Reason for exclusion

Not assigned respiratory support mode by randomisation

Bitondo 2012

Reason for exclusion

Adult crossover study of PSV controlled automatically or by clinician

Chan 1993b

Reason for exclusion

Not assigned respiratory support mode by randomisation

Cheema 2001

Reason for exclusion

Short-term comparison of volume guarantee synchronised ventilation to PTV or SIMV

Clavieras 2013

Reason for exclusion

Adult study comparing methods of pressure support

Cleary 1995

Reason for exclusion

Acute effects of synchronised ventilation

Dani 2006

Reason for exclusion

Short-term randomised comparison of PSV with VG to HFOV

de la Oliva 2012

Reason for exclusion

Non-randomised cross-over study in the paediatric population

De Luca 2009

Reason for exclusion

Cross over trial comparing ACV in time-cycled and flow-cycled modality

deBoer 1993

Reason for exclusion

Not assigned respiratory support mode by randomisation

Dimitriou 1998

Reason for exclusion

Comparison of triggering devices

Duman 2012

Reason for exclusion

Comparison of volume targeting vs pressure limited ventilation in one mode of triggered ventilation

Durand 2001

Reason for exclusion

Randomised pilot study comparing HFOV to SIMV

Estay 2009

Reason for exclusion

Assess the effects of flow sensor dead space during SIMV

Firme 2005

Reason for exclusion

Randomised short-term cross-over study

Friedlich 1999

Reason for exclusion

Nasopharyngeal SIMV versus CPAP

Greenough 1986

Reason for exclusion

Not assigned respiratory support mode by randomisation

Greenough 1987a

Reason for exclusion

Not assigned respiratory support mode by randomisation

Greenough 1987b

Reason for exclusion

Not assigned respiratory support mode by randomisation

Greenough 1988a

Reason for exclusion

Not assigned respiratory support mode by randomisation

Greenough 1988b

Reason for exclusion

Not assigned respiratory support mode by randomisation

Greenough 1991

Reason for exclusion

Not assigned respiratory support mode by randomisation

Gupta 2008

Reason for exclusion

Quasi-experimental cross-over study

Guthrie 2005

Reason for exclusion

Randomised short-term comparison of SIMV and mandatory minute volume

Guven 2013

Reason for exclusion

Comparison of volume guarantee versus pressure-limited ventilation in one mode of triggered ventilation

Herrera 2002

Reason for exclusion

Acute effects of volume-guaranteed SIMV

Hird 1990a

Reason for exclusion

Not assigned respiratory support mode by randomisation

Hird 1990b

Reason for exclusion

Not assigned respiratory support mode by randomisation

Hird 1991a

Reason for exclusion

Not assigned respiratory support mode by randomisation

Hird 1991b

Reason for exclusion

Not assigned respiratory support mode by randomisation

Hird 1991c

Reason for exclusion

Not assigned respiratory support mode by randomisation

Hird 1991d

Reason for exclusion

Not assigned respiratory support mode by randomisation

Hummler 1996

Reason for exclusion

Acute effects of synchronised ventilation

Hummler 1997

Reason for exclusion

Acute effects of mechanical ventilation

Hummler 2006

Reason for exclusion

Randomised short-term cross-over study

Jaber 2005

Reason for exclusion

Randomised short-term cross-over comparison of PSV and volume support ventilation

Jarreau 1996

Reason for exclusion

Acute outcome of synchronised ventilation

John 1994

Reason for exclusion

Comparison of triggering devices

Kapasi 2001

Reason for exclusion

Short-term randomised comparison of ventilation modes

Keszler 2004

Reason for exclusion

Short-term randomised comparison of ventilation modes with ACV with or without volume guarantee

Laubscher 1997

Reason for exclusion

Comparison of triggering devices

Lista 2006

Reason for exclusion

Acute effects of different levels of volume targeting during synchronised intermittent positive pressure ventilation within the context of a randomised trial

Luyt 2001

Reason for exclusion

Acute effects of PTV and conventional ventilation compared within the context of a randomised trial

McCallion 2007

Reason for exclusion

Observational study studying the effects of spontaneous breathing, triggered and untriggered inflations

Migliori 2003

Reason for exclusion

Non randomised comparison of pressure support synchronised ventilation and SIMV

Mitchell 1989

Reason for exclusion

Not assigned respiratory support mode by randomisation

Mizuno 1994

Reason for exclusion

Not assigned respiratory support mode by randomisation

Moretti 1999

Reason for exclusion

Nasal SIPPV to nasal CPAP

Mrozek 2000

Reason for exclusion

Randomised comparison (short-term) of volume-targeted synchronised ventilation and CMV

Nacoti 2012

Reason for exclusion

Paediatric study comparing PSV to PSV with sighs. Non-randomised.

Nafday 2005

Reason for exclusion

Randomised comparison (short-term) of pressure support with volume guarantee

Nakae 1998

Reason for exclusion

Comparison of triggering devices

Nikischin 1996

Reason for exclusion

Comparison of triggering devices

Nishimura 1995

Reason for exclusion

Comparison of triggering devices

Olsen 2002

Reason for exclusion

Cross-over trial comparing pressure support with volume guarantee synchronised ventilation to SIMV

Osorio 2005

Reason for exclusion

Cross-over short-term comparison of SIMV with or without pressure support

Patel 2009

Reason for exclusion

Cross-over trial comparing SIMV and SIMV with pressure support

Polimeni 2006

Reason for exclusion

Short-term cross-over study

Scopesi 2007

Reason for exclusion

Short-term cross-over study

Servant 1992

Reason for exclusion

Not assigned respiratory support mode by randomisation

Smith 1997

Reason for exclusion

Acute outcome of synchronised ventilation

Takeuchi 1994

Reason for exclusion

Not assigned respiratory support mode by randomisation

Thiagarajan 2004

Reason for exclusion

Comparison of triggering devices

Upton 1990

Reason for exclusion

Not assigned respiratory support mode by randomisation

Vishveshwara 1991

Reason for exclusion

Not assigned respiratory support mode by randomisation

Wheeler 2012

Reason for exclusion

Randomised cross-over trial to study the effects of differing back up rates within one mode of triggered ventilation

[top]

References to studies

Included studies

Amini 2013

[CRSSTD: 2746170]

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. [CRSREF: 2746171; PubMed: 23983995]

Baumer 2000

[CRSSTD: 2746172]

Baumer JH. International randomised controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome. Archives of Disease in Childhood 2000;82(1):F5-F10. [CRSREF: 2746173]

Beresford 2000

[CRSSTD: 2746174]

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. [CRSREF: 2746175]

Bernstein 1996

[CRSSTD: 2746176]

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. [CRSREF: 2746177]

Chan 1993

[CRSSTD: 2746178]

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. [CRSREF: 2746179]

Chan 1994

[CRSSTD: 2746180]

Chan V, Greenough A. Comparison of weaning by patient triggered ventilation or synchronous mandatory intermittent ventilation. Acta Paediatrica 1994;83(3):335-7. [CRSREF: 2746181]

Chen 1997

[CRSSTD: 2746182]

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. [CRSREF: 2746183]

Courtney 2002a

[CRSSTD: 2746184]

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. [CRSREF: 2746185; PubMed: 12200551]

Craft 2003a

[CRSSTD: 2746186]

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. [CRSREF: 2746187; PubMed: 12556921]

D'Angio 2005

[CRSSTD: 2746188]

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. [CRSREF: 2746189]

Dimitriou 1995a

[CRSSTD: 2746190]

Dimitriou G, Greenough A, Giffin FJ, Chan V. Synchronous intermittent mandatory ventilation modes versus patient triggered ventilation during weaning. Archives of Disease in Childhood 1995;72(3):F188-90. [CRSREF: 2746191]

Dimitriou 1995b

[CRSSTD: 2746192]

Dimitriou G, Greenough A, Giffin FJ, Chan V. Synchronous intermittent mandatory ventilation modes versus patient triggered ventilation during weaning. Archives of Disease in Childhood 1995;72(3):F188-90. [CRSREF: 2746193]

Donn 1994

[CRSSTD: 2746194]

Donn SM, Nicks JJ, Becker MA. Flow-synchronized ventilation of preterm infants with respiratory distress syndrome. Journal of Perinatology 1994;14(2):90-4. [CRSREF: 2746195]

Erdemir 2014

[CRSSTD: 2746196]

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. [CRSREF: 2746197; PubMed: 24608494]

Heicher 1981

[CRSSTD: 2746198]

Heicher DA, Kasting DS, Harrod JR. Prospective clinical comparison of two methods for mechanical ventilation of neonates: rapid rate and short inspiratory time versus slow rate and long inspiratory time. Journal of Pediatrics 1981;98(6):957-61. [CRSREF: 2746199]

Liu 2011

[CRSSTD: 2746200]

Liu CQ, Cui Z, Xia YF, Ma Li, Fan LL. Randomized controlled study of targeted tidal volume ventilation for treatment of severe neonatal respiratory distress syndrome [Chinese]. Zhongguo Dang Dai Er Ke Za Zhi 2011;13(9):696-9. [CRSREF: 2746201; PubMed: 21924013]

OCTAVE 1991

[CRSSTD: 2746202]

Oxford Region Controlled Trial of Artificial Ventilation (OCTAVE) Study Group. Multicentre randomised controlled trial of high against low frequency positive pressure ventilation. Archives of Disease in Childhood 1991;66(7 Spec No):770-5. [CRSREF: 2746203]

Patel 2012

[CRSSTD: 2746204]

Patel DS, Murthy V, Hannam S, Lee S, Rafferty GF, Greenough A. Randomised weaning trial comparing assist control to pressure support ventilation. Archives of Disease in Childhood. Fetal and Neonatal Edition 2012;97(6):F429-33. [CRSREF: 2746205; PubMed: 22516476]

Pohlandt 1992

[CRSSTD: 2746206]

Pohlandt F, Saule H, Schrîder H, Leonhardt A, Hîrnchen H, Wolff C, Bernsau U, Oppermann H-C. Decreased incidence of extra-alveolar air leakage or death prior to air leakage in high versus low rate positive pressure ventilation: results of a randomised seven-centre trial in preterm infants. European Journal of Pediatrics 1992;151(12):904-9. [CRSREF: 2746207]

Reyes 2006

[CRSSTD: 2746208]

Reyes ZC, Claure N, Tauscher MK, D'Ugard C, Vanbuskirk S, Bancalari E. Randomized, controlled trial comparing synchronized intermittent mandatory ventilation and synchronized intermittent mandatory ventilation plus pressure support in preterm infants. Pediatrics 2006;118(4):1409-17. [CRSREF: 2746209]

Singh 2012

[CRSSTD: 2746210]

Singh S N, Malik G K, Prashanth G P, Singh A, Kumar M. High frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in preterm neonates with hyaline membrane disease: a randomized controlled trial. Indian Journal of Pediatrics 2012;49(5):405-8. [CRSREF: 2746211; PubMed: 22700666]

Sun 2014

[CRSSTD: 2746212]

Sun H, Cheng R, Kang W, Xiong H, Zhou C, Zhang Y, et al. High-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation plus pressure support in preterm infants with severe respiratory distress syndrome. Respiratory Care 2014;59(2):159-69. [CRSREF: 2746213; PubMed: 23764865]

Excluded studies

Abd El-Moneim 2005

[CRSSTD: 2746214]

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. [CRSREF: 2746215]

Abubakar 2005

[CRSSTD: 2746216]

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. [CRSREF: 2746217]

Amitay 1993

[CRSSTD: 2746218]

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. [CRSREF: 2746219]

Bernstein 1993

[CRSSTD: 2746220]

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. [CRSREF: 2746221]

Bitondo 2012

[CRSSTD: 2746222]

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. [CRSREF: 2746223; DOI: 10.1186/cc10733]

Chan 1993b

[CRSSTD: 2746224]

Chan V, Greenough A. Neonatal patient triggered ventilators. Performance in acute and chronic lung disease. Br J Int Care 1993;3:216-9. [CRSREF: 2746225]

Cheema 2001

[CRSSTD: 2746226]

Cheema IU, Ahluwalia JS. Feasibility of tidal volume-guided ventilation in newborn infants: a randomized, crossover trial using the volume guarantee modality. Pediatrics 2001;107:1323-8. [CRSREF: 2746227]

Clavieras 2013

[CRSSTD: 2746228]

Clavieras N, Wysocki M, Coisel Y, Galia F, Conseil M, Chanques G, et al. Prospective randomized crossover study of a new closed-loop control system versus pressure support during weaning from mechanical ventilation. Anesthesiology 2013;119(3):631-41. [CRSREF: 2746229; PubMed: 23619172]

Cleary 1995

[CRSSTD: 2746230]

Cleary JP, Bernstein G, Mannino FL, Heldt BP. Improved oxygenation during synchronized intermittent mandatory ventilation in neonates with respiratory distress syndrome: a randomized, crossover study. Journal of Pediatrics 1995;126(3):407-11. [CRSREF: 2746231]

Dani 2006

[CRSSTD: 2746232]

Dani C, Bertini G, Pezzati M, Filippi L, Pratesi S, Caviglioli C, et al. Effects of pressure support ventilation plus volume guarantee vs high-frequency oscillatory ventilation on lung inflammation in preterm infants. Pediatric Pulmonology 2006;41(3):242-9. [CRSREF: 2746233]

deBoer 1993

[CRSSTD: 2746234]

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. [CRSREF: 2746235]

de la Oliva 2012

[CRSSTD: 2746236]

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. [CRSREF: 2746237; PubMed: 22481227]

De Luca 2009

[CRSSTD: 2746238]

De Luca D, Conti G, Piastra M, Paolillo PM. Flow-cycled versus time-cycled sIPPV in preterm babies with RDS: a breath-to-breath randomised cross-over trial. Archives of Disease in Childhood. Fetal and Neonatal edition 2009;94(6):F397-401. [CRSREF: 2746239; PubMed: 19574255]

Dimitriou 1998

[CRSSTD: 2746240]

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. [CRSREF: 2746241]

Duman 2012

[CRSSTD: 2746242]

Duman N, Tuzun F, Sutcuoglu S, Yesilirmak C D, Kumral A, Ozkan H. Impact of volume guarantee on synchronized ventilation in preterm infants: a randomized controlled trial. Intensive Care Med 2012;38(8):1358-64. [CRSREF: 2746243; PubMed: 22618094]

Durand 2001

[CRSSTD: 2746244]

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. [CRSREF: 2746245]

Estay 2009

[CRSSTD: 2746246]

Estay A, Claure N, D'Ugard C, Organero R, Bancalari E. Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants. Journal of Perinatology 2010;30(7):479-83. [CRSREF: 2746247; PubMed: 20010615]

Firme 2005

[CRSSTD: 2746248]

Firme SR, McEvoy CT, Alconcel C, Tanner J, Durand M. Episodes of hypoxemia during synchronized intermittent mandatory ventilation in ventilator-dependent very low birth weight infants. Pediatric Pulmonology 2005;40(1):9-14. [CRSREF: 2746249]

Friedlich 1999

[CRSSTD: 2746250]

Friedlich P, Lecart C, Posen R, Ramicone E, Chan L, Ramanathan R. A randomized trial of nasopharyngeal synchronized intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birthweight infants after extubation. Journal of Perinatology 1999;19(6 Pt 1):413-18. [CRSREF: 2746251]

Greenough 1986

[CRSSTD: 2746252]

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. [CRSREF: 2746253]

Greenough 1987a

[CRSSTD: 2746254]

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. [CRSREF: 2746255]

Greenough 1987b

[CRSSTD: 2746256]

Greenough A, Greenall F, Gamsu H. Synchronous respiration - which ventilator rate is best? Acta Paediatrica Scandinavica 1987;76(5):713-18. [CRSREF: 2746257]

Greenough 1988a

[CRSSTD: 2746258]

Greenough A, Greenall F. Patient triggered ventilation in premature neonates. Archives of Disease in Childhood 1988;63:77-8. [CRSREF: 2746259]

Greenough 1988b

[CRSSTD: 2746260]

Greenough A, Pool J. Neonatal patient triggered ventilation. Archives of Disease in Childhood 1988;63:394-7. [CRSREF: 2746261]

Greenough 1991

[CRSSTD: 2746262]

Greenough A, Hird MF, Chan V. Airway pressure triggered ventilation for preterm neonates. Journal of Perinatal Medicine 1991;19(6):471-6. [CRSREF: 2746263]

Gupta 2008

[CRSSTD: 2746264]

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. [CRSREF: 2746265; PubMed: 18676412]

Guthrie 2005

[CRSSTD: 2746266]

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. [CRSREF: 2746267]

Guven 2013

[CRSSTD: 2746268]

Guven S, Bozdag S, Saner H, Cetinkaya M, Yazar A S, Erguven M. Early neonatal outcomes of volume guaranteed ventilation in preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med 2013;26(4):396-401. [CRSREF: 2746269; PubMed: 23039373 ]

Herrera 2002

[CRSSTD: 2746270]

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. [CRSREF: 2746271]

Hird 1990a

[CRSSTD: 2746272]

Hird MF, Greenough A. Causes of failure of neonatal patient triggered ventilation. Early Human Development 1990;23(2):101-8. [CRSREF: 2746273]

Hird 1990b

[CRSSTD: 2746274]

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. [CRSREF: 2746275]

Hird 1991a

[CRSSTD: 2746276]

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). [CRSREF: 2746277]

Hird 1991b

[CRSSTD: 2746278]

Hird MF, Greenough A. Patient triggered ventilation in chronically ventilator-dependent infants. European Journal of Pediatrics 1991;150(10):732-4. [CRSREF: 2746279]

Hird 1991c

[CRSSTD: 2746280]

Hird MF, Greenough A. Patient triggered ventilation using a flow triggered system. Archives of Disease in Childhood 1991;66(10 Spec No):1140-3. [CRSREF: 2746281]

Hird 1991d

[CRSSTD: 2746282]

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). [CRSREF: 2746283]

Hummler 1996

[CRSSTD: 2746284]

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. [CRSREF: 2746285]

Hummler 1997

[CRSSTD: 2746286]

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. [CRSREF: 2746287]

Hummler 2006

[CRSSTD: 2746288]

Hummler H, Engelmann A, Pohlandt F, Franz AR. Volume-controlled intermittent mandatory ventilation in preterm infants with hypoxemic episodes. Intensive Care Medicine 2006;32(4):577-84. [CRSREF: 2746289]

Jaber 2005

[CRSSTD: 2746290]

Jaber S, Delay JM, Matecki S, Sebbane M, Eledjam JJ, Brochard L. Volume-guaranteed pressure-support ventilation facing acute changes in ventilatory demand. Intensive Care Medicine 2005;31(9):1181-8. [CRSREF: 2746291]

Jarreau 1996

[CRSSTD: 2746292]

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. [CRSREF: 2746293]

John 1994

[CRSSTD: 2746294]

John J, Bjîrklung LJ, Svenningsen NW, Jonson B. Airway and body surface sensors for triggering in neonatal ventilation. Acta Paediatrica 1994;83(9):903-9. [CRSREF: 2746295]

Kapasi 2001

[CRSSTD: 2746296]

* 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. [CRSREF: 2746297]

Keszler 2004

[CRSSTD: 2746298]

Keszler M, Abubakar K. Volume guarantee: stability of tidal volume and incidence of hypocarbia. Pediatric Pulmonology 2004;38(3):240-5. [CRSREF: 2746299]

Laubscher 1997

[CRSSTD: 2746300]

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. [CRSREF: 2746301]

Lista 2006

[CRSSTD: 2746302]

Lista G, Castoldi F, Fontana P, Reali R, Reggiani A, Bianchi S, et al. Lung inflammation in preterm infants with respiratory distress syndrome: effects of ventilation with different tidal volumes. Pediatric Pulmonology 2006;41(4):357-63. [CRSREF: 2746303]

Luyt 2001

[CRSSTD: 2746304]

Luyt K, Wright D, Baumer JH. Randomised study comparing extent of hypocarbia in preterm infants during conventional and patient triggered ventilation. Archives of Disease in Childhood. Fetal and Neonatal edition 2001;84(1):F14-7. [CRSREF: 2746305]

McCallion 2007

[CRSSTD: 2746306]

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. [CRSREF: 2746307; PubMed: 17686798]

Migliori 2003

[CRSSTD: 2746308]

Migliori C, Cavazza A, Motta M, Chirico G. Effect on respiratory function of pressure support ventilation versus synchronised intermittent mandatory ventilation in preterm infants. Pediatric Pulmonology 2003;35(5):364-7. [CRSREF: 2746309]

Mitchell 1989

[CRSSTD: 2746310]

Mitchell A, Greenough A, Hird MF. Limitations of neonatal patient triggered ventilation. Archives of Disease in Childhood 1989;64:924-9. [CRSREF: 2746311]

Mizuno 1994

[CRSSTD: 2746312]

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. [CRSREF: 2746313]

Moretti 1999

[CRSSTD: 2746316]

Moretti C, Gizzi C, Papoff P, Lampariello S, Capoferri M, Calcagnini G, Bucci G. Comparing the effects of nasal synchronized intermittent positive pressure ventilation (nSIPPV) and nasal continuous positive airway pressure (nCPAP) after extubation in very low birth weight infants. Early Human Development 1999;56(2–3):167–77. [CRSREF: 2746317]

Mrozek 2000

[CRSSTD: 2746318]

Mrozek JD, Bendel-Stenzel EM, Meyers PA, Bing DR, Connett JE, Mammel MC. Randomized controlled trial of volume-targeted synchronized ventilation and conventional intermittent mandatory ventilation following initial exogenous surfactant therapy. Pediatric Pulmonology 2000;29(1):11-8. [CRSREF: 2746319]

Nacoti 2012

[CRSSTD: 2746320]

Nacoti M, Spagnolli E, Bonanomi E, Barbanti C, Cereda M, Fumagalli R. Sigh improves gas exchange and respiratory mechanics in children undergoing pressure support after major surgery. Minerva Anestesiologica 2012;78(8):920-9. [CRSREF: 2746321; PubMed: 22531559]

Nafday 2005

[CRSSTD: 2746322]

Nafday SM, Green RS, Lin J, Brion LP, Ochshorn I, Holzman IR. Is there an advantage of using pressure support ventilation with volume guarantee in the initial management of preterm infants with respiratory distress syndrome? A pilot study. Journal of Perinatology 2005;25(3):193-7. [CRSREF: 2746323]

Nakae 1998

[CRSSTD: 2746324]

Nakae Y, Yamakage M, Horikawa D, Aimono M, Tamiya K, Namiki A. Triggering delay time and work of breathing in three paediatric patient triggered ventilators. Canadian Journal of Anaesthesia 1998;45(3):261-5. [CRSREF: 2746325]

Nikischin 1996

[CRSSTD: 2746326]

Nikischin W, Gerhardt T, Everett R, Gonzalez A, Hummler H, Bancalari E. Patient triggered ventilation: a comparison of tidal volume and chest wall and abdominal motion as trigger signals. Pediatric Pulmonology 1996;22(1):28-34. [CRSREF: 2746327]

Nishimura 1995

[CRSSTD: 2746328]

Nishimura M, Hess D, Kacmarek RM. The response of flow-triggered infant ventilators. American Journal of Respiratory and Critical Care Medicine 1995;152(6 Pt 1):1901-9. [CRSREF: 2746329]

Olsen 2002

[CRSSTD: 2746330]

Olsen SL, Thibeault DW, Truog WE. Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation. Journal of Perinatology 2002;22(6):461-6. [CRSREF: 2746331]

Osorio 2005

[CRSSTD: 2746332]

Osorio W, Claure N, D'Ugard C, Athavale K, Bancalari E. Effects of pressure support during an acute reduction of synchronized intermittent mandatory ventilation in preterm infants. Journal of Perinatology 2005;25(6):412-6. [CRSREF: 2746333]

Patel 2009

[CRSSTD: 2746334]

Patel DS, Rafferty GF, Lee S, Hannam S, Greenough A. Work of breathing during SIMV with and without pressure support. Archives of Disease in Childhood 2009;94(6):434-6. [CRSREF: 2746335; PubMed: 19224888]

Polimeni 2006

[CRSSTD: 2746336]

Polimeni V, Claure N, D'Ugard C, Bancalari E. Effects of volume-targeted synchronized intermittent mandatory ventilation on spontaneous episodes of hypoxemia in preterm infants. Biology of the Neonate 2006;89(1):50-5. [CRSREF: 2746337]

Scopesi 2007

[CRSSTD: 2746338]

Scopesi F, Calevo MG, Rolfe P, Arioni C, Traggiai C, Risso FM, et al. Volume targeted ventilation (volume guarantee) in the weaning phase of premature newborn infants. Paediatric Pulmonology 2007;42(10):864-70. [CRSREF: 2746339; PubMed: 17726708]

Servant 1992

[CRSSTD: 2746340]

Servant GM, Nicks JJ, Donn SM, Bandy KP, Lathrop C, Dechert RE. Feasibility of applying flow-synchronized ventilation to very low birthweight infants. Respiratory Care 1992;37:249-53. [CRSREF: 2746341]

Smith 1997

[CRSSTD: 2746342]

Smith KM, Walig TM, Bing DR, Georgieff MK, Boros SJ, Mammel MC. Lower respiratory rates without decreases in oxygen consumption during neonatal synchronized intermittent mandatory ventilation. Intensive Care Medicine 1997;23(4):463-8. [CRSREF: 2746343]

Takeuchi 1994

[CRSSTD: 2746344]

Takeuchi MK, Itabashi K, Okuyama K. Efficacy of synchronized IMV on weaning neonates from the ventilator. Acta Paediatrica Japonica 1994;36(2):162-6. [CRSREF: 2746345]

Thiagarajan 2004

[CRSSTD: 2746348]

Thiagarajan RR, Coleman DM, Bratton SL, Watson RS, Martin LD. Inspiratory work of breathing is not decreased by flow-triggered sensing during spontaneous breathing in children receiving mechanical ventilation: a preliminary report. Pediatric Critical Care Medicine 2004;5(4):375-8. [CRSREF: 2746349]

Upton 1990

[CRSSTD: 2746350]

Upton CJ, Milner AD, Stokes GM. The effect of changes in inspiratory time on neonatal triggered ventilation. European Journal of Pediatrics 1990;149(9):648-50. [CRSREF: 2746351]

Vishveshwara 1991

[CRSSTD: 2746352]

Vishveshwara N, Freeman B, Peck M, Caliwag N, Shook S, Rajani KB. Patient triggered synchronized assisted ventilation of newborns: report of a preliminary study and three years' experience. Journal of Perinatology 1991;11(4):347-54. [CRSREF: 2746353]

Wheeler 2012

[CRSSTD: 2746354]

Wheeler KI, Morley CJ, Hooper SB, Davis PG. Lower back-up rates improve ventilator triggering during assist-control ventilation: a randomized crossover trial. Journal of Perinatology 2012;32(2):111-6. [CRSREF: 2746355; PubMed: 21637192]

Studies awaiting classification

None noted.

Ongoing studies

None noted.

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Other references

Additional references

None noted.

Other published versions of this review

Greenough 1998

Greenough A, Milner AD, Dimitriou G. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews 1998, Issue 1. Art. No.: CD000456. DOI: 10.1002/14651858.CD000456.

Greenough 2001

Greenough A, Milner AD, Dimitriou G. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD000456. DOI: 10.1002/14651858.CD000456.

Greenough 2004

Greenough A, Milner AD, Dimitriou G. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD000456. DOI: 10.1002/14651858.CD000456.pub2.

Greenough 2008

Greenough A, Dimitriou G, Prendergast M, Milner AD. Synchronized mechanical ventilation for respiratory supporting newborn infants. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000456. DOI: 10.1002/14651858.CD000456.pub3.

Classification pending references

None noted.

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Data and analyses

1 HFPPV vs CMV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
1.1 Death 4 647 Risk Ratio (M-H, Fixed, 95% CI) 0.78 [0.61, 1.00]
1.2 Air leaks 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 1 62 Risk Ratio (M-H, Fixed, 95% CI) 0.25 [0.06, 1.08]
1.4 BPD (oxygen dependency at 28 days) 4 647 Risk Ratio (M-H, Fixed, 95% CI) 1.06 [0.77, 1.46]
1.5 IVH 1 62 Risk Ratio (M-H, Fixed, 95% CI) 0.13 [0.02, 0.94]
 

2 ACV/SIMV vs CMV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
2.1 Death 6 1790 Risk Ratio (M-H, Fixed, 95% CI) 1.17 [0.94, 1.47]
2.2 Air leaks 7 1830 Risk Ratio (M-H, Fixed, 95% CI) 0.98 [0.76, 1.27]
2.3 Duration of ventilation (hours) 5 1463 Mean Difference (IV, Fixed, 95% CI) -38.30 [-53.90, -22.69]
2.4 Extubation failure 4 1056 Risk Ratio (M-H, Fixed, 95% CI) 0.93 [0.68, 1.28]
2.5 Severe IVH 6 1790 Risk Ratio (M-H, Fixed, 95% CI) 1.01 [0.73, 1.40]
2.6 BPD (oxygen dependency at 28 days) 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) 2 1310 Risk Ratio (M-H, Fixed, 95% CI) 0.90 [0.75, 1.08]
 

3 SIMV or SIMV + PS vs HFOV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
3.1 Death 4 996 Risk Ratio (M-H, Fixed, 95% CI) 1.25 [0.91, 1.71]
3.2 BPD: oxygen requirement at 28 days 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 3 869 Risk Ratio (M-H, Fixed, 95% CI) 1.33 [1.07, 1.65]
3.4 Death or BPD 1 356 Risk Ratio (M-H, Fixed, 95% CI) 2.38 [1.41, 4.03]
3.5 Duration of mechanical ventilation 2 466 Mean Difference (IV, Fixed, 95% CI) 1.89 [1.04, 2.74]
3.6 Air leaks 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 4 1010 Risk Ratio (M-H, Fixed, 95% CI) 0.94 [0.71, 1.24]
 

4 ACV vs SIMV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
4.1 Duration of weaning (hours) 3 120 Mean Difference (IV, Fixed, 95% CI) -42.38 [-94.35, 9.60]
4.2 Weaning failure 3 120 Risk Ratio (M-H, Fixed, 95% CI) 0.78 [0.31, 1.93]
4.3 Extubation failure 3 120 Risk Ratio (M-H, Fixed, 95% CI) 1.00 [0.37, 2.67]
4.4 Air leaks 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]
 

5 PS + SIMV versus SIMV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
5.1 Death 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 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 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) 1 107 Risk Ratio (M-H, Fixed, 95% CI) 0.92 [0.41, 2.08]
 

6 PRVCV vs SIMV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
6.1 Death prior to discharge 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 1 185 Risk Ratio (M-H, Fixed, 95% CI) 0.83 [0.55, 1.27]
6.3 Air leak 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 1 203 Risk Ratio (M-H, Fixed, 95% CI) 0.67 [0.29, 1.58]
 

7 PSV vs SIMV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
7.1 Duration of weaning 1 60 Mean Difference (IV, Fixed, 95% CI) -11.30 [-26.53, 3.93]
7.2 Extubation failure 1 60 Risk Ratio (M-H, Fixed, 95% CI) 1.09 [0.57, 2.07]
7.3 Air leaks (total) 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 1 60 Risk Ratio (M-H, Fixed, 95% CI) 1.00 [0.46, 2.17]
 

8 ACV versus PSV

Outcome or Subgroup Studies Participants Statistical Method Effect Estimate
8.1 Duration of weaning 1 Other data No numeric data
 

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Figures

Figure 1

Refer to Figure 1 caption below.

Study flow diagram: review update (Figure 1).

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Sources of support

Internal sources

  • No sources of support provided

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA

    Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201100016C

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Appendices

1 Standard search methodology

PubMed: ((infant, newborn[MeSH] OR newborn OR neonate OR neonatal OR premature OR low birth weight OR VLBW OR LBW or infan* or neonat*) AND (randomized controlled trial [pt] OR controlled clinical trial [pt] OR Clinical Trial[ptyp] OR randomized [tiab] OR placebo [tiab] OR clinical trials as topic [mesh: noexp] OR randomly [tiab] OR trial [ti]) NOT (animals [mh] NOT humans [mh]))

EMBASE: (infant, newborn or newborn or neonate or neonatal or premature or very low birth weight or low birth weight or VLBW or LBW or Newborn or infan* or neonat*) AND (human not animal) AND (randomized controlled trial or controlled clinical trial or randomized or placebo or clinical trials as topic or randomly or trial or clinical trial)

CINAHL: (infant, newborn OR newborn OR neonate OR neonatal OR premature OR low birth weight OR VLBW OR LBW or Newborn or infan* or neonat*) AND (randomized controlled trial OR controlled clinical trial OR randomized OR placebo OR clinical trials as topic OR randomly OR trial OR PT clinical trial)

The Cochrane Library: (infant or newborn or neonate or neonatal or premature or very low birth weight or low birth weight or VLBW or LBW)


This review is published as a Cochrane review in The Cochrane Library, Issue 8, 2016 (see http://www.thecochranelibrary.com External Web Site Policy for information). Cochrane reviews are regularly updated as new evidence emerges and in response to feedback. The Cochrane Library should be consulted for the most recent recent version of the review.