Postura y líquidos para prevenir la cefalea pospunción de la duramadre
Información
- DOI:
- https://doi.org/10.1002/14651858.CD009199.pub3Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 07 marzo 2016see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Dolor y cuidados paliativos
- Copyright:
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- Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
All review authors contributed to the writing of the protocol. IA, AC, and LM conducted the search and selection of studies. IA, LM, XB, and MR conducted data extraction and the 'Risk of bias' assessment. IA and MR were in charge of all the statistical analyses. All review authors contributed to writing the final document. IA entered data into RevMan and will carry out futures updates of this review.
Sources of support
Internal sources
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Fundación Universitaria de Ciencias de la Salud/ Hospital de San José‐ Hospital Infantil de San José, Colombia
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Institute for Clinical Effectiveness and Health Policy IECS, Argentina
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Iberoamerican Cochrane Centre, Spain
External sources
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Agencia de Calidad del Sistema Nacional de Salud, Ministry of Health, Spain
Declarations of interest
Ingrid Arevalo‐Rodriguez has no conflicts of interest to declare.
Agustín Ciapponi has no conflicts of interest to declare.
Marta Roqué i Figuls has no conflicts of interest to declare.
Luis Muñoz has no conflicts of interest to declare.
Xavier Bonfill Cosp has no conflicts of interest to declare.
Acknowledgements
Cochrane Review Group funding acknowledgement: the National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pain, Palliative and Supportive Care Review Group. Disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, National Health Service (NHS), or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2016 Mar 07 | Posture and fluids for preventing post‐dural puncture headache | Review | Ingrid Arevalo-Rodriguez, Agustín Ciapponi, Marta Roqué-Figuls, Luis Muñoz, Xavier Bonfill Cosp | |
| 2013 Jul 12 | Posture and fluids for preventing post‐dural puncture headache | Review | Ingrid Arevalo‐Rodriguez, Agustín Ciapponi, Luis Munoz, Marta Roqué i Figuls, Xavier Bonfill Cosp | |
| 2011 Jul 06 | Posture and fluids for preventing post‐dural puncture headache | Protocol | Ingrid Arévalo‐Rodríguez, Agustín Ciapponi, Luis Munoz, Ramon A Quintero, Xavier Bonfill Cosp | |
Differences between protocol and review
This updated review modified the previous quality assessment of the secondary outcome "severe PDPH" from moderate to low, considering that the 95% CI 0.68 to 1.41 could lead to opposite recommendations related to bed rest. In addition, we changed the statistical analyses from a fixed‐effect model to a random‐effect models in order to take into account all possible sources of heterogeneity not measured. However, despite these changes, conclusions of this review remain unchanged.
Notes
Assessed for updating in 2016
This review has now been stabilised following discussion with the authors and editors. We are confident that no potentially relevant studies likely to change the conclusions will be published within the standard two year period. The review will be re‐assessed for updating in five years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially to necessitate revisions.
Assessed for updating in 2021
In March 2021 we did not identify any potentially relevant studies likely to change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be reassessed for updating in five years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICO
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Funnel plot of comparison: 1 Bed rest versus ambulation, outcome: 1.1 Post‐dural puncture headache.
Forest plot for reason for puncture: bed rest versus ambulation, outcome: 2.1 Post‐dural puncture headache.
Comparison 1: Bed rest versus immediate ambulation, Outcome 1: PDPH
Comparison 1: Bed rest versus immediate ambulation, Outcome 2: Severe PDPH
Comparison 1: Bed rest versus immediate ambulation, Outcome 3: Any headache
Comparison 2: Reason for puncture: bed rest versus immediate ambulation, Outcome 1: PDPH
Comparison 2: Reason for puncture: bed rest versus immediate ambulation, Outcome 2: Severe PDPH
Comparison 2: Reason for puncture: bed rest versus immediate ambulation, Outcome 3: Any headache
Comparison 3: Supine versus prone, Outcome 1: Any headache
Comparison 4: Supine versus supine with head tilt, Outcome 1: Any headache
Comparison 5: Fluids versus less or no fluids, Outcome 1: Any headache
Comparison 6: Sensitivity analysis/low risk of bias: bed rest versus ambulation, Outcome 1: PDPH
| Bed rest versus ambulation for preventing post‐dural puncture headache | ||||||
| Patient or population: Participants undergoing lumbar puncture | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Ambulation | Bed rest | |||||
| Post‐dural puncture headache | 205 per 1000 | 254 per 1000 | RR 1.24 | 1519 | ⊕⊕⊕⊝ | |
| Severe post‐dural puncture headache | 107 per 1000 | 105 per 1000 | RR 0.98 | 1568 | ⊕⊕⊝⊝ | |
| Any headache | 287 per 1000 | 333 per 1000 | RR 1.16 | 2477 | ⊕⊕⊕⊝ | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Downgraded (‐1) due to unclear risk of bias related to allocation concealment (9 studies), as well as high risk of bias in blinding of outcome assessment (6 studies). | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 PDPH Show forest plot | 12 | 1519 | Risk Ratio (M‐H, Random, 95% CI) | 1.24 [1.04, 1.48] |
| 1.2 Severe PDPH Show forest plot | 9 | 1568 | Risk Ratio (M‐H, Random, 95% CI) | 0.98 [0.68, 1.41] |
| 1.3 Any headache Show forest plot | 18 | 2477 | Risk Ratio (M‐H, Random, 95% CI) | 1.16 [1.02, 1.32] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 PDPH Show forest plot | 12 | 1519 | Risk Ratio (M‐H, Random, 95% CI) | 1.24 [1.04, 1.48] |
| 2.1.1 Diagnostic | 6 | 723 | Risk Ratio (M‐H, Random, 95% CI) | 1.11 [0.90, 1.37] |
| 2.1.2 Myelography | 1 | 207 | Risk Ratio (M‐H, Random, 95% CI) | 1.48 [0.67, 3.27] |
| 2.1.3 Anesthesia | 4 | 381 | Risk Ratio (M‐H, Random, 95% CI) | 1.82 [1.19, 2.78] |
| 2.1.4 Mixed | 1 | 208 | Risk Ratio (M‐H, Random, 95% CI) | 1.27 [0.68, 2.35] |
| 2.2 Severe PDPH Show forest plot | 9 | 1568 | Risk Ratio (M‐H, Random, 95% CI) | 0.98 [0.68, 1.41] |
| 2.2.1 Diagnostic | 3 | 509 | Risk Ratio (M‐H, Random, 95% CI) | 0.93 [0.62, 1.38] |
| 2.2.2 Myelography | 2 | 582 | Risk Ratio (M‐H, Random, 95% CI) | 0.97 [0.59, 1.60] |
| 2.2.3 Anesthesia | 3 | 269 | Risk Ratio (M‐H, Random, 95% CI) | 2.45 [0.89, 6.72] |
| 2.2.4 Mixed | 1 | 208 | Risk Ratio (M‐H, Random, 95% CI) | 0.25 [0.05, 1.15] |
| 2.3 Any headache Show forest plot | 18 | 2477 | Risk Ratio (M‐H, Random, 95% CI) | 1.16 [1.02, 1.32] |
| 2.3.1 Diagnostic | 6 | 723 | Risk Ratio (M‐H, Random, 95% CI) | 1.15 [0.94, 1.40] |
| 2.3.2 Myelography | 7 | 1165 | Risk Ratio (M‐H, Random, 95% CI) | 1.06 [0.89, 1.26] |
| 2.3.3 Anesthesia | 4 | 381 | Risk Ratio (M‐H, Random, 95% CI) | 1.85 [1.27, 2.71] |
| 2.3.4 Mixed | 1 | 208 | Risk Ratio (M‐H, Random, 95% CI) | 1.27 [0.68, 2.35] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Any headache Show forest plot | 3 | 239 | Risk Ratio (M‐H, Random, 95% CI) | 0.97 [0.68, 1.37] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Any headache Show forest plot | 2 | 87 | Risk Ratio (M‐H, Random, 95% CI) | 1.72 [1.10, 2.69] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Any headache Show forest plot | 2 | 200 | Risk Ratio (M‐H, Random, 95% CI) | 0.94 [0.66, 1.34] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 PDPH Show forest plot | 2 | 380 | Risk Ratio (M‐H, Random, 95% CI) | 1.18 [0.90, 1.54] |
