Evidence map›Paper›PMID 41781628›Full record

SynthesisCanadian journal of anaesthesia = Journal canadien d'anesthesie2026

Effect of therapeutic interventions combined with lung-protective ventilation on long-term mortality of patients with acute respiratory distress syndrome: a network meta-analysis.

Hiroko Aoyama, Kanji Uchida, Kazuyoshi Aoyama, Alan Yang, Petros Pechlivanoglou, Marina Englesakis, Yoshitsugu Yamada, Eddy Fan

Abstract readNetwork Meta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Beyond network rankings: caution in long-term acute respiratory distress syndrome survival interpretation.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Hiroko AoyamaInterdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada. hiroko.aoyama@mail.utoronto.ca.ORCID 0000-0002-5752-7116
Kanji UchidaDepartment of Anesthesiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Kazuyoshi AoyamaDepartment of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
Alan YangHospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
Petros PechlivanoglouHospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
Marina EnglesakisLibrary & Information Services, The Institute of Education Research (TIER), University Health Network, Toronto, ON, Canada.
Yoshitsugu YamadaDepartment of Anesthesiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Eddy FanInterdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeLong-term effects of ventilatory strategies/adjunctive therapies received in the intensive care unit on mortality of patients with acute respiratory distress syndrome (ARDS) is uncertain. To explore 180-day mortality in adult patients with ARDS, we conducted a network meta-analysis (NMA) comparing the effects of various prespecified interventions added to lung-protective ventilation (LPV). SOURCE: We systematically searched six databases on 8 November 2024. Two reviewers independently identified eligible randomized clinical trials with published Kaplan-Meier curves, exploring prespecified interventions combined with LPV and LPV alone. Data were synthesized with NMA of survival curves using Bayesian random effects fractional polynomial models. PRINCIPAL

findingsTwenty-two trials with 8,653 participants assessed six different interventions added to LPV (open lung strategy, neuromuscular blockade [NMBA], corticosteroids, high-frequency oscillatory ventilation [HFOV], prone positioning, and venovenous extracorporeal membrane oxygenation [VV ECMO]), compared with LPV alone. We did not include inhaled pulmonary vasodilator trials. The primary NMA computed survival probability of each intervention on the basis of survival probability of LPV alone at 180 days (0.52; 95% credible interval, 0.49 to 0.55). Compared with LPV alone, 1) the evidence suggests prone positioning results in a reduction in 180-day mortality; 2) an open lung strategy does not reduce 180-day mortality; 3) VV ECMO, NMBA, and corticosteroids may reduce 180-day mortality (very uncertain); and 4) HFOV may increase 180-day mortality (very uncertain). We extrapolated reported mortalities to 180-day mortality in 16 trials, where there might be discrepancy between raw and extrapolated numbers in event rate.

conclusionsProne positioning may improve long-term mortality in patients with ARDS. STUDY REGISTRATION: PROSPERO ( CRD42019131849 ); first submitted 26 April 2019.

Indexed as

Respiration, ArtificialRespiratory Distress SyndromeBayes TheoremExtracorporeal Membrane OxygenationHigh-Frequency VentilationHumansIntensive Care UnitsNeuromuscular BlockadeProne PositionRandomized Controlled Trials as Topicacute respiratory distress syndromeintensive care unit interventionslong-term mortalitynetwork meta-analysissurvival curvesystematic review

Identifiers

PMID41781628

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.