Comparative analysis of efficacy and pain management in acute respiratory failure: a systematic review and meta-analysis

Background: This meta-analysis aims to evaluate the efficacy and pain management outcomes of various interventions in patients with acute respiratory failure (ARF) in intensive care settings. Methods: To identify randomized controlled trials (RCTs) evaluating the effectiveness and outcomes of interventions for ARF in pain management, a thorough search was performed on the Ovid Medline database until August 2024. The quality of the studies was evaluated following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Effect sizes and 95% confidence intervals (CI) were computed utilizing a random-effects model, while heterogeneity was evaluated using I2 statistics. Results: A total of 3000 participants from five studies were analyzed. The interventions demonstrated varying levels of efficacy and pain management outcomes, with overall significant efficacy (effect size 1.40, 95% CI: 1.05 to 1.87). Nevertheless, the results of pain management exhibited an overall tendency towards negative effect sizes, suggesting difficulties in effectively managing pain through the various interventions. The level of heterogeneity was deemed moderate (I2 = 26%), highlighting variations in research methodologies and the characteristics of the patient cohorts. Conclusion: This meta-analysis indicates that while certain interventions significantly improve clinical outcomes in ARF patients, pain management remains a challenge. The results indicate a necessity for holistic strategies that blend effectiveness with patient well-being. Future studies should prioritize refining treatments to enhance both effectiveness and pain relief in the management of ARF. The INPLASY Registration: Our meta-analysis protocol was registered in INPLASY (registration number: INPLASY2024100058) and can be found at https://inplasy.com/inplasy-2024-10-0058/.