Comparative Efficacy of Bronchiolitis Interventions in Acute Care: A Network Meta-analysis

被引：22
作者：
Elliott, Sarah Alexandra [1 ,2 ]
Gaudet, Lindsay A. [1 ]
Fernandes, Ricardo M. [2 ,3 ,4 ]
Ben Vandermeer [2 ]
Freedman, Stephen B. [5 ,6 ,7 ,8 ]
Johnson, David W. [5 ,6 ,7 ,8 ]
Plint, Amy C. [9 ,10 ]
Klassen, Terry P. [11 ,12 ]
Allain, Dominic [13 ,14 ]
Hartling, Lisa [1 ,2 ]
机构：
[1] Univ Alberta, Edmonton Clin Hlth Acad, Fac Med & Dent, Alberta Res Ctr Hlth Evidence, Edmonton, AB, Canada
[2] Univ Alberta, Edmonton Clin Hlth Acad, Fac Med & Dent, Dept Pediat,Cochrane Child Hlth, Edmonton, AB, Canada
[3] Univ Lisbon, Fac Med, Inst Med Mol, Clin Pharmacol & Therapeut Lab, Ave Prof Egas Moniz, Lisbon, Portugal
[4] Hosp Santa Maria, Dept Pediat, Ave Prof Egas Moniz, Lisbon, Portugal
[5] Univ Calgary, Alberta Childrens Hosp Res Inst, Cumming Sch Med, Dept Pediat, Calgary, AB, Canada
[6] Univ Calgary, Alberta Childrens Hosp Res Inst, Cumming Sch Med, Dept Emergency Med, Calgary, AB, Canada
[7] Univ Calgary, Alberta Childrens Hosp Res Inst, Cumming Sch Med, Dept Physiol & Pharmacol, Calgary, AB, Canada
[8] Alberta Childrens Hosp Fdn, Calgary, AB, Canada
[9] Univ Ottawa, Fac Med, Dept Pediat, Div Emergency Med, Ottawa, ON, Canada
[10] Childrens Hosp Eastern Ontario, Ottawa, ON, Canada
[11] Univ Manitoba, Childrens Hosp Res Inst Manitoba, Max Rudy Sch Med, Winnipeg, MB, Canada
[12] Univ Manitoba, Dept Pediat & Child Hlth, Max Rudy Sch Med, Winnipeg, MB, Canada
[13] Univ Alberta, Fac Med & Dent, Dept Emergency Med, Div Pediat Emergency Med, Edmonton, AB, Canada
[14] Stollery Childrens Hosp, Edmonton, AB, Canada
来源：
PEDIATRICS | 2021年 / 147卷 / 05期
基金：
加拿大健康研究院;
关键词：
HYPERTONIC SALINE;
D O I：
10.1542/peds.2020-040816
中图分类号：
R72 [儿科学];
学科分类号：
100202 ;
摘要：
Using NMA and the most recent trial evidence, we compare the effectiveness of treatments for bronchiolitis in children aged <= 2 years in this systematic review. CONTEXT: Uncertainty exists as to which treatments are most effective for bronchiolitis, with considerable practice variation within and across health care sites. OBJECTIVE: A network meta-analysis to compare the effectiveness of common treatments for bronchiolitis in children aged <= 2 years. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, , and the World Health Organization International Clinical Trials Registry Platform were searched from inception to September 1, 2019. STUDY SELECTION: A total 150 randomized controlled trials comparing a placebo or active comparator with any bronchodilator, glucocorticoid steroid, hypertonic saline solution, antibiotic, helium-oxygen therapy, or high-flow oxygen therapy were included. DATA EXTRACTION: Data were extracted by 1 reviewer and independently verified. Primary outcomes were admission rate on day 1 and by day 7 and hospital length of stay. Strength of evidence was assessed by using Confidence in Network Meta-Analysis . RESULTS: Nebulized epinephrine (odds ratio: 0.64, 95% confidence interval [CI]: 0.44 to 0.93, low confidence) and nebulized hypertonic saline plus salbutamol (odds ratio: 0.44, 95% CI: 0.23 to 0.84, low confidence) reduced the admission rate on day 1. No treatment significantly reduced the admission rate on day 7. Nebulized hypertonic saline (mean difference: -0.64 days, 95% CI: -1.01 to -0.26, low confidence) and nebulized hypertonic saline plus epinephrine (mean difference: -0.91 days, 95% CI: -1.14 to -0.40, low confidence) reduced hospital length of stay. LIMITATIONS: Because we did not report adverse events in this analysis, we cannot make inferences about the safety of these treatments. CONCLUSIONS: Although hypertonic saline alone, or combined with epinephrine, may reduce an infant's stay in the hospital, poor strength of evidence necessitates additional rigorous trials.
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页数：13
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