Summary of findings 6. Duration of mechanical ventilation.

Estimate of effects, confidence intervals, and certainty of the evidence for duration of mechanical ventilation for paediatric patients undergoing surgery for congenital heart disease
Population: paediatric patients undergoing surgery for congenital heart disease Interventions: levosimendan, milrinone, dobutamine, placebo, levosimendan + milrinone + dopamine, milrinone + dopamine, levosimendan + dobutamine, milrinone + dobutamine Comparator (reference): placebo or combination of milrinone + dopamine or combination of milrinone + dobutamine Outcome: duration of mechanical ventilation Setting: inpatient								Figure 6
Total studies: 9 Total participants: 577	Relative effect (95% CI)	Anticipated absolute effect (95% CI)			No. of participants (studies)	Certainty of the evidence	Ranking (SUCRA*)	Comments
		Without intervention	With intervention	Difference
Levosimendan	ROM 1.17 (0.65 to 2.12) Network estimate	39.5 hoursa	46.2 hours	6.7 hours more (13.8 less to 44.2 more)	225 (7 RCTs)	Moderate Due to imprecision	0.42	Levosimendan likely increases the duration of mechanical ventilation slightly, compared to placebo
Milrinone	ROM 1.25 (0.67 to 2.36) Network estimate	39.5 hoursa	49 hours	9.9 hours more (13 less to 53.7 more)	222 (7 RCTs)	Moderate Due to imprecision	0.30	Milrinone likely increases the duration of mechanical ventilation, compared to placebo
Dobutamine	ROM 1.04 (0.45 to 2.38) Network estimate	39.5 hoursa	41.1 hours	1.6 hours more (21.7 less to 54.5 more)	51 (2 RCTs)	Moderate Due to imprecision	0.61	Dobutamine likely results in no difference in the duration of mechanical ventilation, compared to placebo
Placebo	ROM 1	Not estimable	Not estimable	Not estimable	214 (4 RCTs)	Reference comparator	0.66	‐
Heterogeneity: tau2 = 0.1475; I2 = 67.9% (95% CI 28.7% to 85.5%) Q total 18.67 (df = 6; P = 0.0048) Q within designs 11.73 (df = 4; P = 0.0195) Q between designs 6.94 (df = 2; P = 0.0311)

*SUCRA: surface under the cumulative ranking curve, calculated with R package netmeta

GRADE Working Group grades of evidence (or certainty in the evidence)

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

Explanatory footnotes

^aBaseline risk (assumed control risk) obtained from Wang 2019, placebo group, median duration of mechanical ventilation.

Certainty of the evidence for each intervention was downgraded one step due to imprecision, resulting in 'Moderate'.

Abbreviation(s)
CI: confidence interval; df: degrees of freedom; No.: number; RCT: randomised controlled trial; ROM: ratio of means; SUCRA: surface under the cumulative ranking curve.