Hodgson 2011.

Methods	Prospective, single‐centre, parallel‐group RCT
Participants	n = 20. Inclusion criteria: ARDS, PaO2/FiO2< 200, age > 15 years in 1 ICU in Australia (2007 to 2009) Excluded if chest trauma, intercostal catheter with air leak, pneumothorax, bronchospasm, raised ICP, MAP ≤ 60 mmHg, significant arrhythmias or MV > 72 hours
Interventions	Treatment: staircase recruitment manoeuvre to peak of 55 cm H2O airway pressure and decremental PEEP titration to determine optimal PEEP, performed daily with PCV, VT < 6 mL/kg Pplat < 30 mmHg, permissive hypercapnia. Additionally, RM with PEEP = 40 cm H2O for 1 minute was performed after oxygen desaturation or circuit disconnection Control: ARDSnet protocol, with ACVC and FiO2/PEEP titration, VT < 6 mL/kg, plateau pressure < 30 mmHg
Outcomes	Daily for 7 days: interleukins (IL‐6, IL‐1β, IL‐8) and tumour necrosis factor (TNF‐α), Ppeak, Pplat, VT, RR, PEEP, HR and rhythm, CVP, blood pressure, inotrope usage, arterial blood gases, PaO2/FiO2, static lung compliance ICU LOS, hospital LOS, duration of MV Hospital survival
Notes	The first author of this Cochrane review declares a conflict of interest, as she is the first study author on this publication. Data were extracted by independent researchers (see Declarations of interest).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computerized random block schedule, stratified by diagnosis of severe sepsis
Allocation concealment (selection bias)	Low risk	Sequentially numbered sealed opaque envelopes
Blinding (performance bias and detection bias) All outcomes	Low risk	Open‐label design Blinding of treatment: no Blinding of assessor: not stated Blinding of data analysis: not stated
Incomplete outcome data (attrition bias) All outcomes	Low risk	Data were reported for all participants.
Selective reporting (reporting bias)	Low risk	Outcomes listed in the methods were reported in the results.
Intention to treat	Low risk	Primary analysis was by intention‐to‐treat.