Abstract
IntroductionThe effects of different mechanical ventilation (MV) modes on mortality outcome in infants with respiratory distress syndrome (RDS) are not well known.MethodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published through April 2014 that assessed mortality in infants with RDS given different MV modes. We assessed studies for eligibility, extracted data, and subsequently pooled the data. A Bayesian fixed-effects model was used to combine direct comparisons with indirect evidence. We also performed sensitivity analyses and rankings of the competing treatment modes.ResultsIn total, 20 randomized controlled trials were included for the network meta-analysis, which consisted of 2,832 patients who received one of 16 ventilation modes. Compared with synchronized intermittent mandatory ventilation (SIMV) + pressure support ventilation (PSV), time-cycled pressure-limited ventilation (TCPL) (hazard ratio (HR) 0.290; 95% confidence interval (CI) 0.071 to 0.972), high-frequency oscillatory ventilation (HFOV) (HR 0.294; 95% CI 0.080 to 0.852), SIMV + volume-guarantee (VG) (HR 0.122; 95% CI 0.014 to 0.858), and volume-controlled (V-C) (HR 0.139; 95% CI 0.024 to 0.677) ventilation modes are associated with lower mortality. The combined results of available ventilation modes were not significantly different in regard to the incidences of patent ductus arteriosus and intraventricular hemorrhage.ConclusionCompared with the SIMV + PSV ventilation mode, the TCPL, HFOV, SIMV + VG, and V-C ventilation modes are associated with lower mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0843-7) contains supplementary material, which is available to authorized users.
Highlights
The effects of different mechanical ventilation (MV) modes on mortality outcome in infants with respiratory distress syndrome (RDS) are not well known
MV remains an essential and life-saving technique to care for preterm infants with RDS for whom non-invasive ventilation fails [1]
Compared with the synchronized intermittent mandatory ventilation (SIMV) + pressure support ventilation (PSV) mode, the time-cycled pressure-limited ventilation (TCPL), high-frequency oscillatory ventilation (HFOV), SIMV + VG, and V-C modes were associated with a reduction in mortality in the infants with RDS
Summary
The effects of different mechanical ventilation (MV) modes on mortality outcome in infants with respiratory distress syndrome (RDS) are not well known. Respiratory distress syndrome (RDS) is a common clinical disease that results from the deficiency of alveolar surfactant along with the structural immaturity of the lungs in preterm infants [1]. RDS remains the primary cause of infant mortality [3]. The European Consensus Guidelines [1] for 2013 recommend that non-invasive respiratory support be used at birth for all infants at risk for RDS, thereby avoiding a greater chance of mechanical ventilation (MV) [4]. MV remains an essential and life-saving technique to care for preterm infants with RDS for whom non-invasive ventilation fails [1]
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