Flow-cycled versus time-cycled synchronized ventilation for neonates.
BACKGROUND
Synchronized ventilation of neonates is standard care in industrialized countries. Both flow-cycled and time-cycled modes of synchronized ventilation are in widespread use for assisted ventilation of neonates.


OBJECTIVE
To determine the effect of flow-cycled versus time-cycled synchronized ventilation on the risk of bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age (PMA) in neonates requiring assisted ventilation.


METHODS
We used the standard methods of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 4, 2009, PubMed (January 1966 to October 2009), EMBASE (January 1974 to October 2009) and CINAHL (January 1982 to October 2009). We checked references and cross-references from identified studies. Abstracts from the proceedings of the Pediatric Academic Societies Meetings (from January 1990 to October 2009) were handsearched. We placed no restrictions on language.


METHODS
Randomized or quasi-randomized clinical trials comparing flow-cycled with time-cycled synchronized endotracheal ventilation in neonates, reporting on at least one outcome of interest were eligible for inclusion in the review.


METHODS
One author (SMS) searched the literature as described above. Selection of studies and data extraction were done separately by two authors (SMS and SKP). Any disagreements were resolved by discussion involving all authors.


RESULTS
Only two small, short-term, randomized, individual cross-over trials involving a total of 19 preterm neonates met the inclusion criteria of this review. Both trials reported on lung mechanics and short-term respiratory physiology outcomes but not on clinical morbidities or mortality.


CONCLUSIONS
There is insufficient evidence to determine the safety and efficacy of flow-cycled compared to time-cycled synchronized ventilation in neonates. Large randomized clinical trials using a parallel-group design and reporting on clinically important outcomes are warranted.
Schulzke
Sven M
SM
Department of Neonatology, University of Basel Children's Hospital (UKBB), Spitalstrasse 21, Basel, Switzerland, 4031.
Pillow
Jane
J
Ewald
Ben
B
Patole
Sanjay K
SK
D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy; D015656:Respiratory Mechanics / Q000502:physiology