Broncodilatadores para la bronquiolitis
Appendices
Appendix 1. Details of previous searches
In 1998, three computerized bibliographic databases were searched for all publications in all languages examining bronchodilator therapy of bronchiolitis: the National Library of Medicine MEDLINE database (1966 to September 1994); the Excerpta Medica database (1974 to November 1994); and Reference Update® (Research Information Systems, Carlsbad, California) (November 8, 1993, June 29, 1994 and April 26, 1995). The MEDLINE search was repeated June 2, 1998. The search terms "explode bronchiolitis" and "albuterol" or "ipratropium" or "adrenergic agents" or "bronchodilator agents" were used. In addition, the bibliographies of all articles selected were searched for relevant studies.
For the 2010 updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library 2010, Issue 1) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1966 to Week 2, March 2010), EMBASE (1998 to March 2010) and reference lists of articles. In addition, we reviewed the files of one author (AG) and conducted a handsearch of reference lists of new studies. We searched presentations given at the Pediatric Academic Societies meetings in 2009 and 2010 for pending studies and found no clinical trials.
We searched MEDLINE and CENTRAL using the following keywords and MeSH terms. The MEDLINE search was combined with the Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity‐ and precision‐maximizing version (2008 revision); Ovid format (Lefebvre 2009) These search terms were adapted to search EMBASE.com.
MEDLINE (OVID)
1 exp BRONCHIOLITIS/
2 bronchiolit$
3 or/1‐2 (2208)
4 exp Bronchodilator Agents/
5 bronchodilator$
6 exp ALBUTEROL/
7 albuterol
8 salbutamol
9 exp IPRATROPIUM/
10 ipratropium
11 exp Adrenergic Agents/
12 adrenergic agent$
13 or/4‐12
14 3 and 13
Embase.com
17. #13 AND #16
16. #14 OR #15
15. random*:ab,ti OR placebo*:ab,ti OR factorial*:ab,ti OR crossover*:ab,ti OR 'cross over':ab,ti OR volunteer*:ab,ti OR assign*:ab,ti OR allocat*:ab,ti OR ((doubl* OR singl*) NEAR/2 (mask* OR blind*)):ab,ti
14. 'randomized controlled trial'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp
13. #3 AND #12
12. #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11
11. 'adrenergic agent':ab,ti OR 'adrenergic agents':ab,ti
10. 'adrenergic receptor stimulating agent'/exp
9. ipratropium:ab,ti
8. 'ipratropium bromide'/de
7. albuterol:ab,ti OR salbutamol:ab,ti
6. 'salbutamol'/exp
5. bronchodilat*:ab,ti
4. 'bronchodilating agent'/exp
3. #1 OR #2
2.
*:ab,ti
1. 'bronchiolitis'/exp
Appendix 2. Embase.com search strategy
#17 #3 AND #8 AND #16
#16 #11 NOT #15
#15 #12 NOT #14
#14 #12 AND #13
#13 'human'/de
#12 'animal'/de OR 'nonhuman'/de OR 'animal experiment'/de
#11 #9 OR #10
#10 random*:ab,ti OR placebo*:ab,ti OR trial:ti OR allocat*:ab,ti OR crossover*:ab,ti OR 'cross over':ab,ti OR (doubl* NEXT/1 blind*):ab,ti
#9 'randomized controlled trial'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp
#8 #4 OR #5 OR #6 OR #7
#7 albuterol:ab,ti OR salbutamol:ab,ti OR terbutaline:ab,ti OR ipratropium:ab,ti OR 'adrenergic agent':ab,ti OR 'adrenergic agents':ab,ti
#6 'salbutamol'/de OR 'terbutaline'/de OR 'ipratropium bromide'/de OR 'adrenergic receptor stimulating agent'/exp
#5 bronchodilator*:ab,ti
#4 'bronchodilating agent'/exp
#3 #1 OR #2
#2 bronchiolit*:ab,ti
#1 'bronchiolitis'/exp
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 1 Oxygen saturation measured by pulse oximetry: inpatient and outpatient settings.
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 2 Sub‐analysis ‐ oxygen saturation (outpatients treated with albuterol/salbutamol).
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 3 Improvement in clinical score (dichotomous).
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 4 Average clinical score after treatment: by treatment setting (continuous).
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 5 Sub‐analysis ‐ average clinical score (outpatients treated with albuterol/salbutamol).
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 6 Hospital admission after treatment (outpatients treated with albuterol or salbutamol).
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 7 Duration of hospitalization (inpatients).
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 8 Time to resolution of illness (outpatients).
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 9 Sensitivity analysis ‐ oxygen saturation low risk of bias studies.
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 10 Sensitivity analysis ‐ average clinical score low risk of bias studies.
Comparison 1 Bronchodilators compared to placebo for treatment of acute bronchiolitis, Outcome 11 Sensitivity analysis ‐ average clinical score using RDAI (outpatients).
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Oxygen saturation measured by pulse oximetry: inpatient and outpatient settings Show forest plot | 25 | 1242 | Mean Difference (IV, Random, 95% CI) | ‐0.43 [‐0.92, 0.06] |
| 1.1 Inpatient studies | 12 | 495 | Mean Difference (IV, Random, 95% CI) | ‐0.62 [‐1.40, 0.16] |
| 1.2 Outpatient studies | 13 | 747 | Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.61, 0.11] |
| 2 Sub‐analysis ‐ oxygen saturation (outpatients treated with albuterol/salbutamol) Show forest plot | 10 | 572 | Mean Difference (IV, Random, 95% CI) | ‐0.19 [‐0.59, 0.21] |
| 3 Improvement in clinical score (dichotomous) Show forest plot | 7 | 365 | Odds Ratio (M‐H, Random, 95% CI) | 0.18 [0.06, 0.50] |
| 3.1 Inpatient | 5 | 208 | Odds Ratio (M‐H, Random, 95% CI) | 0.20 [0.05, 0.79] |
| 3.2 Outpatient | 2 | 157 | Odds Ratio (M‐H, Random, 95% CI) | 0.11 [0.01, 1.46] |
| 4 Average clinical score after treatment: by treatment setting (continuous) Show forest plot | 21 | 1086 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐0.54, ‐0.05] |
| 4.1 Inpatient studies | 9 | 416 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.41, 0.12] |
| 4.2 Outpatient studies | 12 | 670 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.42 [‐0.79, ‐0.06] |
| 5 Sub‐analysis ‐ average clinical score (outpatients treated with albuterol/salbutamol) Show forest plot | 9 | 532 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.36 [‐0.83, 0.11] |
| 6 Hospital admission after treatment (outpatients treated with albuterol or salbutamol) Show forest plot | 11 | 710 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.46, 1.21] |
| 6.1 Nebulized | 8 | 404 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.44, 1.33] |
| 6.2 Oral in ED setting | 1 | 37 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.32 [0.03, 3.21] |
| 6.3 Oral at home | 2 | 269 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.28, 2.64] |
| 7 Duration of hospitalization (inpatients) Show forest plot | 6 | 349 | Mean Difference (IV, Fixed, 95% CI) | 0.06 [‐0.27, 0.39] |
| 8 Time to resolution of illness (outpatients) Show forest plot | 2 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.29 [‐0.43, 1.00] |
| 9 Sensitivity analysis ‐ oxygen saturation low risk of bias studies Show forest plot | 15 | 793 | Mean Difference (IV, Random, 95% CI) | ‐0.38 [‐0.75, 0.00] |
| 9.1 Inpatient | 4 | 210 | Mean Difference (IV, Random, 95% CI) | ‐0.65 [‐1.77, 0.48] |
| 9.2 Outpatient | 11 | 583 | Mean Difference (IV, Random, 95% CI) | ‐0.29 [‐0.66, 0.08] |
| 10 Sensitivity analysis ‐ average clinical score low risk of bias studies Show forest plot | 15 | 734 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.22 [‐0.41, ‐0.03] |
| 10.1 Inpatient | 5 | 228 | Std. Mean Difference (IV, Random, 95% CI) | 0.01 [‐0.35, 0.37] |
| 10.2 Outpatient | 10 | 506 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.32 [‐0.54, ‐0.09] |
| 11 Sensitivity analysis ‐ average clinical score using RDAI (outpatients) Show forest plot | 4 | 240 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.11 [‐0.48, 0.25] |
