Background National Institute for Health and Clinical Effectiveness (NICE), UK, guideline published in 2019 recommends the use of volume-targeted ventilation (VTV). It recommends synchronised intermittent mandatory ventilation (SIMV) over the modes that support-all-breaths, for example, assist control ventilation (ACV). We conducted a systematic review and meta-analysis of the studies comparing SIMV mode with triggered modes supporting all breaths.
Methods Patients: Neonates receiving mechanical ventilation.
Intervention: SIMV ventilation.
Comparison: Modes that support-all-breaths: ACV, pressure support ventilation and neurally adjusted ventilation.
Outcomes: Death before discharge and bronchopulmonary dysplasia (BPD) at 36 weeks’ corrected gestation, weaning duration, incidence of air leaks, extubation failure, postnatal steroid use, patent ductus arteriosus requiring treatment, severe (grade 3/4) intraventricular haemorrhage, periventricular leukomalacia and neurodevelopmental outcome at 2 years.
Randomised or quasi-randomised clinical trials comparing SIMV with triggered ventilation modes supporting all breaths in neonates, reporting on at least one outcome of interest were eligible for inclusion in the review.
Results Seven publications describing eight studies fulfilled the eligibility criteria. No significant difference in mortality (OR 0.74, 95% CI 0.32 to 1.74) or BPD at 36 weeks (OR 0.63, 95% CI 0.33 to 1.24), but the weaning duration was significantly shorter in support-all-breaths group with a mean difference of −22.67 hours (95% CI –44.33 to –1.01). No difference in any other outcomes.
Conclusion Compared with SIMV, synchronised modes supporting all breaths are associated with a shorter weaning duration with no statistically significant difference in mortality, BPD at 36 weeks or other outcomes. Larger studies with explicit ventilator and weaning protocols are needed to compare these modes in the current neonatal population.
PROSPERO registration number The review was prospectively registered with PROSPERO: CRD42020207601.
Data availability statement
Data are available on reasonable request. As a systematic review and meta-analysis, authors have used the data from published studies and used Cochrane methodology to synthesise results. Data will be shared on a reasonable request.
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Contributors DB proposed this study, and DJ and NB worked with DB to design the study protocol submission for registration with PROSPERO. DB and NB conducted independent database search and then reviewed the lists with DJ. All three authors contributed to data acquisition, analysis, and interpretation. All three authors contributed to drafting of manuscript and approved the final version. DB is
responsible for the overall content as the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.