for the main comparison.
| Recruitment manoeuvres compared with standard care for adults with acute respiratory distress syndrome who were mechanically ventilated | ||||||
|
Patient or population: mechanically ventilated adults with acute respiratory distress syndrome. Participants were recruited from ICUs internationally, including Australia, Brazil, China, Europe, Canada, Korea, Seoul, Taiwan and the United States. Settings: intensive care unit Intervention: recruitment manoeuvres Comparison: standard care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Intervention | |||||
| 28‐Day mortality | Risk for the population | RR 0.86 (0.74 to 1.01) | 1450 (5 studies) | ⊕⊕⊝⊝ Lowa | Four of the 5 trials include co‐interventions that may influence the result of the outcome. | |
| 347 per 1000 | 294 per 1000 | |||||
| ICU mortality | Risk for the population | RR 0.83 (0.72 to 0.97) | 1370 (5 studies) | ⊕⊕⊝⊝ Lowa | Four of the 5 trials include co‐interventions that may influence the result of the outcome. | |
| 362 per 1000 | 303 per 1000 | |||||
| In‐hospital mortality | Risk for the population | RR 0.88 (0.77 to 1.01) | 1313 (4 studies) | ⊕⊕⊝⊝ Lowa | Three of the 4 trials include co‐interventions that may influence the result of the outcome. | |
| 405 per 1000 | 356 per 1000 | |||||
| Rate of barotrauma | Risk for the population | RR 1.09 (0.78 to 1.51) | 1508 (7 studies) | ⊕⊕⊕⊝ Moderateb | ||
| 90 per 1000 | 86 per 1000 | |||||
| *The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aLung recruitment manoeuvres were used with co‐interventions that may affect the result of the outcome (Hodgson 2011; Meade 2008; Huh 2009; Kacmarek 2016; Liu 2011). We downgraded the quality of the evidence by two levels for indirectness of evidence. We made this decision a priori.
bWe noted no heterogeneity among trial effect estimates but observed that reported confidence intervals around effect estimates were wide. We downgraded the quality of the evidence by one level for imprecision in results.