Implications for practice
The principal result of this study was the finding of a lack of clinical research evidence of effect to address the study's objectives. At this time, we are not able to make any recommendations for clinical practice based on the results of this review.
Implications for research
The findings of this review should raise awareness of the lack of evidence guiding the selection of PEEP levels in preterm infants undergoing CMV for RDS or BPD.
Trials addressing the study objectives are warranted. This includes trials evaluating the effects of different levels of PEEP in infants undergoing CMV for both RDS and BPD. Trials comparing the effect of different strategies for determining an 'optimal', individualized PEEP level based on available patient data and characteristics are also warranted.
Trials evaluating the effects of these interventions should examine outcomes that are important to the patient, such as mortality and neurodevelopmental outcomes, and be aware of the limitations resulting from cross-over trials. In instances in which cross-over trials are performed, researchers should be mindful of the importance of presenting data in such a way that data can be isolated following the end of each cross-over period.
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