TY - JOUR
T1 - Mucoactive agents for acute respiratory failure in the critically ill: A systematic review and meta-analysis
AU - Anand, Rohan
AU - McAuley, Daniel F.
AU - Blackwood, Bronagh
AU - Yap, Chee
AU - Oneill, Brenda
AU - Connolly, Bronwen
AU - Borthwick, Mark
AU - Shyamsundar, Murali
AU - Warburton, John
AU - Meenen, David Van
AU - Paulus, Frederique
AU - Schultz, Marcus J.
AU - Dark, Paul
AU - Bradley, Judy M.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Purpose Acute respiratory failure (ARF) is a common cause of admission to intensive care units (ICUs). Mucoactive agents are medications that promote mucus clearance and are frequently administered in patients with ARF, despite a lack of evidence to underpin clinical decision making. The aim of this systematic review was to determine if the use of mucoactive agents in patients with ARF improves clinical outcomes. Methods We searched electronic and grey literature (January 2020). Two reviewers independently screened, selected, extracted data and quality assessed studies. We included trials of adults receiving ventilatory support for ARF and involving at least one mucoactive agent compared with placebo or standard care. Outcomes included duration of mechanical ventilation. Meta-analysis was undertaken using random-effects modelling and certainty of the evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation. Results Thirteen randomised controlled trials were included (1712 patients), investigating four different mucoactive agents. Mucoactive agents showed no effect on duration of mechanical ventilation (seven trials, mean difference (MD)-1.34, 95% CI-2.97 to 0.29, I 2 =82%, very low certainty) or mortality, hospital stay and ventilator-free days. There was an effect on reducing ICU length of stay in the mucoactive agent groups (10 trials, MD-3.22, 95% CI-5.49 to-0.96, I 2 =89%, very low certainty). Conclusion Our findings do not support the use of mucoactive agents in critically ill patients with ARF. The existing evidence is of low quality. High-quality randomised controlled trials are needed to determine the role of specific mucoactive agents in critically ill patients with ARF. PROSPERO registration number CRD42018095408.
AB - Purpose Acute respiratory failure (ARF) is a common cause of admission to intensive care units (ICUs). Mucoactive agents are medications that promote mucus clearance and are frequently administered in patients with ARF, despite a lack of evidence to underpin clinical decision making. The aim of this systematic review was to determine if the use of mucoactive agents in patients with ARF improves clinical outcomes. Methods We searched electronic and grey literature (January 2020). Two reviewers independently screened, selected, extracted data and quality assessed studies. We included trials of adults receiving ventilatory support for ARF and involving at least one mucoactive agent compared with placebo or standard care. Outcomes included duration of mechanical ventilation. Meta-analysis was undertaken using random-effects modelling and certainty of the evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation. Results Thirteen randomised controlled trials were included (1712 patients), investigating four different mucoactive agents. Mucoactive agents showed no effect on duration of mechanical ventilation (seven trials, mean difference (MD)-1.34, 95% CI-2.97 to 0.29, I 2 =82%, very low certainty) or mortality, hospital stay and ventilator-free days. There was an effect on reducing ICU length of stay in the mucoactive agent groups (10 trials, MD-3.22, 95% CI-5.49 to-0.96, I 2 =89%, very low certainty). Conclusion Our findings do not support the use of mucoactive agents in critically ill patients with ARF. The existing evidence is of low quality. High-quality randomised controlled trials are needed to determine the role of specific mucoactive agents in critically ill patients with ARF. PROSPERO registration number CRD42018095408.
KW - ARDS
KW - assisted ventilation
KW - critical care
KW - non invasive ventilation
UR - http://www.scopus.com/inward/record.url?scp=85088257015&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/thoraxjnl-2019-214355
DO - https://doi.org/10.1136/thoraxjnl-2019-214355
M3 - Article
C2 - 32513777
SN - 0040-6376
VL - 75
SP - 623
EP - 631
JO - Thorax
JF - Thorax
IS - 8
ER -