Patient–ventilator asynchrony, impact on clinical outcomes and effectiveness of interventions: a systematic review and meta-analysis

Table 2 Summary of findings in the eight studies focused on patient–ventilator asynchrony in ventilated patients in Part A

Overview of study design
Patients or study population: adult patients requiring mechanical ventilation in the ICU Exposure: high patient–ventilator asynchrony Comparison: low patient–ventilator asynchrony
Outcome	Illustrative comparative risks^d (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Intervention
Duration of mechanical ventilation (days)	Study population		–	673 (8 studies)	⊕⊕⊝⊝ Low^a,b
Duration of mechanical ventilation (days)		MD: 5.16 (2.38 to 7.94)	–	673 (8 studies)	⊕⊕⊝⊝ Low^a,b
ICU mortality	Study population		OR2.73 (1.76 to 4.24)	576 (6 studies)	⊕⊕⊝⊝ Low^a,b
ICU mortality	267 per 1000	498 per 1000 (390 to 607)	OR2.73 (1.76 to 4.24)	576 (6 studies)	⊕⊕⊝⊝ Low^a,b
Hospital mortality	Study population		OR1.94 (1.14 to 3.30)	420 (6 studies)	⊕⊕⊝⊝ Low^a,b
Hospital mortality	348 per 1000	509 per 1000 (378 to 638)	OR1.94 (1.14 to 3.30)	420 (6 studies)	⊕⊕⊝⊝ Low^a,b
Incidence of reintubation	Study population		OR2.21 (0.72 to 8.83)	363 (4 studies)	⊕⊕⊝⊝ Low^a,c
Incidence of reintubation	110 per 1000	214 per 1000 (82 to 457)	OR2.21 (0.72 to 8.83)	363 (4 studies)	⊕⊕⊝⊝ Low^a,c
Incidence of tracheostomy	Study population		OR2.13 (0.96 to 4.71)	425 (5 studies)	⊕⊕⊝⊝ Low^a,c
Incidence of tracheostomy	133 per 1000	246 per 1000 (128 to 420)	OR2.13 (0.96 to 4.71)	425 (5 studies)	⊕⊕⊝⊝ Low^a,c

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect
CI, confidence interval; ICU, intensive care unit; MD, mean difference; OR, odds ratio
^aDowngraded one point because of a high risk of bias associated with statistical analysis and reporting
^bDowngraded one point because of imprecise (optimal information size)
^cDowngraded one point because of imprecise (confidence interval)
^dThe corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect (and its 95% CI) estimated for the intervention group. Assumed risk was estimated from the meta-analysis of control risks

ISSN: 2052-0492