Agarwal 2013.

Methods	Randomized controlled trial in a single respiratory ICU
Participants	Adults with acute respiratory distress syndrome
Interventions	Intervention: ASV. Patients were stabilized on volume control assist ventilation for 1 hour to determine the adequate minute ventilation.Peak pressure alarm was set at 45 cm H2O to avoid Pplat ≥35 cm H2O. Subsequent manipulation of %MV was guided by interpretation of the following parameters: Pinsp, spontaneous respiratory frequency while on ASV (fspont) and target respiratory frequency (ftarget) calculated by the ASV algorithm. If the fspont was greater than ftarget by 10 breaths and/or associated was hypoxaemia (PaO2 <55 mm Hg or SpO2 <88%) or hypercapnic acidosis (pH <7.25), then the %MV was escalated by 20%. If the fspont was similar to ftarget without any hypercapnoea or hypoxaemia, then the %MV was de‐escalated by 10%. The pressurization slope (percentage of the inspiratory time taken to reach the peak pressure) was maintained at 25% for all subjects. Weaning comprised sequential decrease in %MV every 2 h (or earlier). Spontaneous breathing trial was considered once %MV was ≤ 70% and Pinsp was ≤ 8 cmH2O. Patients were extubated if able to tolerate the spontaneous breathing trial for 60 min. Control: assist control mode ventilation using low tidal volume strategy of 6ml/kg to maintain plateau pressures < 30 cm H2O and pH > 7.3 with option to reduce tidal volume to 4 ml/kg and increase respiratory rate to 35/ min to achieve the above said goals. PSV weaning commenced once PEEP and FiO2 requirements decreased to 8 cm H2O and 0.4 respectively. The PS used was the Pplat recorded during VCV (PSmax). PS was decreased by 2 cmH2O every 6 h (or earlier) until PS of 7 cmH2O. A 1 hour SBT viaT‐piece off ventilator was then performed. FIO2/PEEP was set according to ARDSnet protocol for both study arms to maintain SpO2 of 88–92% at minimum possible FiO2.
Outcomes	Duration of mechanical ventilation Duration of ICU stay Duration of hospital stay Mortality Ease of use of ventilator mode Frequency of blood gas analysis
Notes	NCT01165528
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomization sequence was computer generated
Allocation concealment (selection bias)	Low risk	Assignments were placed in sealed opaque envelopes
Incomplete outcome data (attrition bias) All outcomes	Low risk	No attrition, no missing outcome data
Selective reporting (reporting bias)	Low risk	All pre‐specified outcomes are reported
Other bias	Low risk	No other sources of bias detected
Blinding of participants and personnel (performance bias) All outcomes	High risk	Assumed as high risk due to the nature of the intervention
Blinding of outcome assessment (detection bias) All outcomes	High risk	Outcome assessors were also involved in treatment of patients