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Cochrane Database of Systematic Reviews

Prostaciclinas en aerosol para el síndrome de dificultad respiratoria aguda (SDRA)

Información

DOI:
https://doi.org/10.1002/14651858.CD007733.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 14 agosto 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Atención crítica y de emergencia

Copyright:
  1. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Arash Afshari

    Correspondencia a: Juliane Marie Centre ‐ Anaesthesia and Surgical Clinic Department 4013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    [email protected]

    [email protected]

  • Anders Bastholm Bille

    Department of Anaesthesia, Juliane Marie Centret, Rigshospitalet, Copenhagen, Denmark

  • Mikkel Allingstrup

    Juliane Marie Centre ‐ Anaesthesia and Surgical Clinic Department 4013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Contributions of authors

Updated review (2017)

AA, ABB and MA: involved in literature search, quality assessment and data abstraction of trials.

AA and MA: involved in writing the review.

Original published review

(Afshari 2010)

All four authors (Arash Afshari, Jesper Brok, Jørn Wetterslev and Ann Merete Møller) were involved in protocol development, literature searching, quality assessment and data abstraction of trials, and writing the review.

Sources of support

Internal sources

  • Cochrane Anaesthesia Critical and Emergency Care Group (CARG), Denmark.

    Support from former trial search co‐ordinator (Karen Hovhannisyan) in designing search strategy

External sources

  • No sources of support supplied

Declarations of interest

AA: none known.

ABB: none known.

MA: none known.

Acknowledgements

We would like to thank Dr Peter Dahlem and Dr Shahla Siddiqui for providing further information about their trials.

From the Cochrane Anaesthesia, Critical and Emergency Care Group we would like to thank:

Prof Harald Herkner (content editor), Jing Xie (statistical editor), Neill Adhikari (peer reviewer), Janet Wale (consumer editor), Janne Vendt (trial search co‐ordinator) for their help and editorial advice during the preparation of this updated systematic review.

We would also like to thank Karen Hovhannisyan (former trials search co‐ordinator) for his assistance in providing our different search strategies and Jane Cracknell (Managing Editor) for her valuable assistance during the entire process.

Finally, special thanks to Prof Harald Herkner and Prof Nathan L Pace for their great editorial criticism and assistance, enabling us to improve the overall quality of the first edition of this paper (Afshari 2010).

Version history

Published

Title

Stage

Authors

Version

2017 Aug 14

Aerosolized prostacyclins for acute respiratory distress syndrome (ARDS)

Review

Arash Afshari, Anders Bastholm Bille, Mikkel Allingstrup

https://doi.org/10.1002/14651858.CD007733.pub3

2010 Aug 04

Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

Review

Arash Afshari, Jesper Brok, Ann Merete Møller, Jørn Wetterslev

https://doi.org/10.1002/14651858.CD007733.pub2

2009 Apr 15

Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

Protocol

Arash Afshari, Jesper Brok, Ann Merete Møller, Jørn Wetterslev

https://doi.org/10.1002/14651858.CD007733

Differences between protocol and review

May 2017

The title of this review has been changed. Acute lung injury is no longer mentioned in the title of the review. As described in Description of the condition section, the term 'acute lung injury' no longer exists and has instead been replaced by a new ARDS definition based on the severity of hypoxaemia; the title of this updated review reflects this change.

Furthermore, in this updated review, we decided to expand our 'Risk of bias' table. Therefore, we added the following domains: blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias) and other bias. We also added two 'Risk of bias' figures (Figure 2; Figure 3).

We also applied the principles of the GRADE approach to provide an overall assessment of the evidence relating to our outcomes. We constructed a summary of findings Table for the main comparison table using GRADEpro software.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Child; Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Summary of findings for the main comparison. Aerosolized prostacyclin compared to placebo for acute respiratory distress syndrome (ARDS)

Aerosolized prostacyclin compared to placebo for acute respiratory distress syndrome (ARDS)

Patient or population: people with ARDS

Setting: intensive care unit in the Netherlands and Pakistan

Intervention: aerosolized prostacyclin

Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with aerosolized prostacyclin

Mortality

Study population

RR 1.50
(0.17 to 12.94)

14
(1 study)

⊕⊝⊝⊝
Very low1,2,3,4

Only 1 small paediatric trial with cross‐over design provided mortality data (Dahlem 2004). Thus, no meta‐analysis carried out.

167 per 1000

250 per 1000
(28 to 1000)

PaO2/FiO2 ratio5

‐

MD 25.35 lower
(60.48 lower to 9.78 higher)

‐

67
(1 study)

⊕⊝⊝⊝
Very low6

Only 1 trial provided data (Siddiqui 2013). Thus, no meta‐analysis was carried out.

Improvement in mean pulmonary arterial pressure

‐

‐

‐

‐

‐

No data is available for meta‐analysis (Characteristics of included studies, Siddiqui 2013)

Adverse events7

‐

‐

‐

81

(2 studies)

⊕⊝⊝⊝
Very low8

Only descriptive assessment of safety with no available data to carry out meaningful analyses (Dahlem 2004; Siddiqui 2013).

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; FiO2: fraction of inspired oxygen; MD: mean difference; PaO2: partial pressure of oxygen in arterial blood; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: 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 quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

1Mortality at 28 to 30 days.

2Required information size for paediatric population depending on the level of heterogeneity adjustment was between 2897 (I2 = 0) and 3862 (I2 = 25%).
3Required information size for the adult population depending on the same level of heterogeneity was between 1132 (I2 = 0) and 1508 (I2 = 25%).

4This outcome was downgraded from high to low quality of evidence due to limitations in design (small sample size, few events, cross‐over design) suggesting high likelihood of bias, indirectness of evidence and high probability of publication bias. (Dahlem 2004).

5Despite the fact that biochemical markers of clinical outcomes are often not included in SoF tables, we have chosen to include this outcomes since it is widely used in clinical practice to guide treatment.

6The outcome was downgraded two levels (from high to very low quality of evidence) for very serious imprecision due to small sample size, few events and wide 95% CI suggesting high likelihood of bias and indirectness of evidence. (Siddiqui 2013).

7Adverse events such as bleeding or organ dysfunction

8The outcome was downgraded two levels (from high to very low quality of evidence) for very serious imprecision due to small sample size and few events and since only descriptive assessment of safety and adverse events were provided in the included trials with no data being available for meta‐analyses.

Figuras y tablas -
Summary of findings for the main comparison. Aerosolized prostacyclin compared to placebo for acute respiratory distress syndrome (ARDS)
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