Dongelmans 2009.

Methods	Single centre randomized controlled trial
Participants	128 adults (intervention 64:control 64) ≥18 years of age after uncomplicated coronary artery bypass grafting without a history of pulmonary disease or haemodynamic instability. Excluded patients comprised those with pulmonary disease or history of pulmonary surgery, intraaortic balloon pump on admission to ICU, receiving inotropes and/pr vasopressors at a rate higher than usual (upper limits in milligrams per hour: dopamine 20, norepinephrine 0.5, dobutamine 25, and epinephrine at any rate). Setting: The Netherlands, 28 bed ICU of academic medical centre. Staffing comprised 140 nurses, 8 full‐time intensivists, 8 ICU fellows, and 10 residents of other specialties
Interventions	Intervention: Adaptive Support Ventilation with the minute ventilation was set at 100% of the theoretical value based on predicted body weight, FiO2 of 50%, PEEP of 10 cmH2O (maintained constant for 4 hours after which it was set to 5cmH2O until extubation), maximum airway pressure of 35 cmH2O equivalent to an absolute Pinsp limit of 25cmH2O, flow trigger 2 L/s. Arterial blood gas (ABG) analysis was performed 30 minutes after connection to the ventilator. If the PaCO2 was <3.5 kPa or >5.5 kPa, minute ventilation was decreased or increased by 10%. Any modification of ventilator settings was followed after 30 minutes by an ABG. Extubation criteria included: responsive and cooperative, urine output >0.5 mL/kg/hr, chest drainage <100 mL last hour, no uncontrolled arrhythmia, rectal temperature >36.0C, respiratory frequency of 10‐20 breaths/min without machine‐controlled breaths, FiO2 40% and Pinsp 5‐10 cmH2O for 30 minutes. Control: Pressure Control Ventilation with VT of 6‐8 mL/kg predicted body weight, respiratory rate of 12‐15 breaths/min, FiO2, PEEP and flow trigger at same settings as ASV group. Respiratory rate was increased or decreased to satisfy ASV PaCO2 criteria on ABG taken 30 minutes after ventilation commenced. Any modification of ventilator settings was followed after 30 minutes by an ABG. When patients breathed spontaneously, the mode was switched to PSV set at 10 cmH2O, support was decreased to 5‐10 cmH2O depending on VT. Extubation criteria were the same as ASV group.
Outcomes	Primary endpoint was time to tracheal extubation. Secondary endpoints were the duration of assisted ventilation as the proportion of the total duration of ventilation of MV and switches from controlled ventilation to assisted ventilation. Also studied ASV with respect to VT, airway pressures, respiratory rate, and ABG results
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Allocation in random order (author communication)
Allocation concealment (selection bias)	Low risk	Opaque, sealed envelopes used
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	Not possible due to nature of intervention
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessors were not involved in daily care of patients. Assumed as low risk due to the objective nature of outcomes (weaning commencement/extubation)