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Cochrane Database of Systematic Reviews

Intervenciones para el tratamiento de la gangrena gaseosa

Información

DOI:
https://doi.org/10.1002/14651858.CD010577.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 03 diciembre 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Heridas

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Zhirong Yang

    Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

    Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

  • Jing Hu

    Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

  • Yanji Qu

    Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

  • Feng Sun

    Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

  • Xisheng Leng

    Department of Surgery, Peking University People's Hospital, Beijing, China

  • Hang Li

    Dermatologic Department, Peking University First Hospital, Beijing, China

  • Siyan Zhan

    Correspondencia a: Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

    [email protected]

Contributions of authors

Siyan Zhan: conceived, designed and co‐ordinated the review; completed the first draft of the review and performed part of writing and editing the review; approved the final version prior to submission; advised on the review; secured funding; performed previous work that was the foundation of the review; and is the guarantor of the review.

Zhirong Yang: conceived and designed the review; extracted data and undertook quality assessment; performed part of writing and editing the review; approved the final version prior to submission; advised on the review; and performed previous work that was the foundation of the current review.

Jing Hu: co‐ordinated the review; extracted data and undertook quality assessment; performed part of writing and editing the review; and approved the final version prior to submission.

Yanji Qu: co‐ordinated the review; checked quality of data extraction; checked quality assessment; performed part of writing and editing the review; and approved the final version prior to submission.

Feng Sun: co‐ordinated the review; checked quality of data extraction, analysed and interpreted data and checked quality assessment; performed statistical analysis and checked quality of statistical analysis; performed part of writing and editing the review; and approved the final version prior to submission.

Xisheng Leng: designed the review; analysed and interpreted data; performed part of writing and editing the review; advised on the review; and approved the final version prior to submission.

Hang Li: designed the review; analysed and interpreted data; performed part of writing and editing the review; advised on the review; and approved the final version prior to submission.

Contributions of editorial base

Nicky Cullum: edited the protocol; advised on methodology, interpretation and protocol content.
Joan Webster: edited the review; advised on methodology, interpretation and review content.
Sally Bell‐Syer: edited the protocol and the review; advised on methodology, interpretation and content;
Gill Rizzello: co‐ordinated the editorial process; edited the review.
Ruth Foxlee: designed the search strategy
Reetu Child edited the search methods section.

Sources of support

Internal sources

  • Peking University, China.

  • University of Cambridge, UK.

External sources

  • This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Wounds. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health, UK.

Declarations of interest

Zhirong Yang: none known.
Jing Hu: none known.
Yanji Qu: none known.
Feng Sun: none known.
Xisheng Leng: none known.
Hang Li: none known.
Siyan Zhan: none known.

Acknowledgements

Many thanks also to peer referees (Elizabeth McInnes, Mark Rodgers, Marialena Trivella, Dirk Ubbink, Uwe Wollina, Gillian Ray‐Barruel, and Durhane Wong‐Rieger, Bestun Ahmed) and copy‐editor Elizabeth Royle.

Version history

Published

Title

Stage

Authors

Version

2015 Dec 03

Interventions for treating gas gangrene

Review

Zhirong Yang, Jing Hu, Yanji Qu, Feng Sun, Xisheng Leng, Hang Li, Siyan Zhan

https://doi.org/10.1002/14651858.CD010577.pub2

2013 Jun 06

Interventions for treating gas gangrene

Protocol

Zhirong Yang, Jing Hu, Yanji Qu, Feng Sun, Xisheng Leng, Hang Li, Siyan Zhan

https://doi.org/10.1002/14651858.CD010577

Differences between protocol and review

We did not perform the quantitative synthesis we planned in our protocol due to the small number of included studies and the substantial clinical heterogeneity between them. We assessed quality of the evidence using GRADE system, which was not planned in our protocol.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

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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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Forest plot of comparison: 1 Additional Chinese herbs versus no additional Chinese herbs, outcome: 1.1 Cure rate.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Additional Chinese herbs versus no additional Chinese herbs, outcome: 1.1 Cure rate.

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Forest plot of comparison: 2 Additional topical HBOT versus additional systemic HBOT, outcome: 2.1 Cure rate.
Figuras y tablas -
Figure 5

Forest plot of comparison: 2 Additional topical HBOT versus additional systemic HBOT, outcome: 2.1 Cure rate.

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Comparison 1 Additional Chinese herbs versus no additional Chinese herbs, Outcome 1 Cure rate.
Figuras y tablas -
Analysis 1.1

Comparison 1 Additional Chinese herbs versus no additional Chinese herbs, Outcome 1 Cure rate.

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Comparison 2 Additional topical HBOT versus additional systemic HBOT, Outcome 1 Cure rate.
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Analysis 2.1

Comparison 2 Additional topical HBOT versus additional systemic HBOT, Outcome 1 Cure rate.

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Summary of findings for the main comparison. Summary of findings. Additional Chinese herbs compared with no additional Chinese herbs for treating gas gangrene

Additional Chinese herbs compared with no additional Chinese herbs for treating gas gangrene

Patient or population: patients with gas gangrene
Setting: a general hospital with 400 beds and 1.6 million outpatients per year
Intervention: additional Chinese herbs
Comparison: no additional Chinese herbs

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no Chinese herbs

Risk with Chinese herbs

Cure rate
follow up: range 2 weeks to 8 weeks

Study population

RR 3.08
(1.00 to 9.46)

46
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2

150 per 1000

462 per 1000
(150 to 1000)

*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; 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

1 Downgraded two levels due to limitations in design; high risk of performance and reporting bias, and unclear risk of bias in other bias sources.

2 Downgraded two levels due to imprecision; only one trial with small sample size and very wide confidence interval that included the possibility of an effect in either direction (crosses line of no effect).

Figuras y tablas -
Summary of findings for the main comparison. Summary of findings. Additional Chinese herbs compared with no additional Chinese herbs for treating gas gangrene
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Summary of findings 2. Summary of findings. Additional topical HBOT compared with additional systemic HBOT for treating gas gangrene

Additional topical HBOT compared with additional systemic HBOT for treating gas gangrene

Patient or population: patients with gas gangrene
Setting: a general hospital with 520 beds and 0.2 million outpatients per year
Intervention: additional topical HBOT
Comparison: additional systemic HBOT

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with systemic HBOT

Risk with Topical HBOT

Cure rate
follow up: mean 10 days

Study population

RR 1.10
(0.25 to 4.84)

44
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2

130 per 1000

143 per 1000
(33 to 631)

*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; RR: Risk ratio; HBOT: hyperbaric oxygen therapy.

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

1 Downgraded two levels due to limitations in design; high risk of performance and reporting bias, and unclear risk of bias in selection and detection bias.

2 Downgraded two levels for imprecision; only one trial with small sample size and very wide confidence interval that included the possibility of an effect in either direction (crosses line of no effect).

Figuras y tablas -
Summary of findings 2. Summary of findings. Additional topical HBOT compared with additional systemic HBOT for treating gas gangrene
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Table 1. Search strategies for databases in Chinese and trial registries

Search strategies

China Biological Medicine Database (CBM‐disc)

#1 "气性坏疽"[常用字段:智能]
#2 "梭菌"[常用字段:智能]
#3 "梭状"[常用字段:智能]
#4 "肌坏死"[常用字段:智能]
#5 "肌炎"[常用字段:智能]
#6 (#2) OR (#3)
#7 (#4) OR (#5)
#8 (#6) AND (#7)
#9 (#1) OR (#8)

China National Knowledge Infrastructure (CNKI)

(主题="气性坏疽") OR ((主题="梭菌"+"梭状") AND (主题="肌坏死"+"肌炎"))

Chinese scientific periodical database of VIP INFORMATION (VIP)

((题名或关键词=肌坏死 或 文摘=肌坏死 或 题名或关键词=肌炎 或 文摘=肌炎 与 专业=经济管理+图书情报+教育科学+自然科学+农业科学+医药卫生+工程技术+社会科学 与 范围=全部期刊) 与 (题名或关键词=梭状 或 文摘=梭状 或 题名或关键词=梭菌 或 文摘=梭菌 与 专业=经济管理+图书情报+教育科学+自然科学+农业科学+医药卫生+工程技术+社会科学 与 范围=全部期刊)) 或者 (题名或关键词=气性坏疽 或 文摘=气性坏疽 与 专业=经济管理+图书情报+教育科学+自然科学+农业科学+医药卫生+工程技术+社会科学 与 范围=全部期刊)

Science Citation Index

Gas gangrene or clostridi* myonecrosis

ClinicalTrials.gov (www.clinicaltrials.gov)

"Gas Gangrene"(By topics)

Current Controlled Trials (www.controlled‐trials.com)

"gas gangrene" or "myonecrosis"

WHO International Clinical Trials Registry Platform (www.who.int/trialsearch)

gas gangrene or clostridi* myonecrosis or non‐clostridi* myonecrosis or nonclostridi* myonecrosis

Australian New Zealand Clinical Trials Registry (www.anzctr.org.au)

"gas gangrene" or "clostridial myonecrosis" or "non‐clostridial myonecrosis" or "nonclostridial myonecrosis"

Figuras y tablas -
Table 1. Search strategies for databases in Chinese and trial registries
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Comparison 1. Additional Chinese herbs versus no additional Chinese herbs

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cure rate Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

3.08 [1.00, 9.46]
Figuras y tablas -
Comparison 1. Additional Chinese herbs versus no additional Chinese herbs
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Comparison 2. Additional topical HBOT versus additional systemic HBOT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cure rate Show forest plot

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.25, 4.84]
Figuras y tablas -
Comparison 2. Additional topical HBOT versus additional systemic HBOT
Ir a la tabla de la revisión