Publication: Mucoactive agents for acute respiratory failure in the critically ill: A systematic review and meta-analysis
Issued Date
2020-08-01
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ISSN
14683296
00406376
00406376
Other identifier(s)
2-s2.0-85088257015
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Mahidol University
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SCOPUS
Bibliographic Citation
Thorax. Vol.75, No.8 (2020), 623-631
Suggested Citation
Rohan Anand, Daniel F. McAuley, Bronagh Blackwood, Chee Yap, Brenda Oneill, Bronwen Connolly, Mark Borthwick, Murali Shyamsundar, John Warburton, David Van Meenen, Frederique Paulus, Marcus J. Schultz, Paul Dark, Judy M. Bradley Mucoactive agents for acute respiratory failure in the critically ill: A systematic review and meta-analysis. Thorax. Vol.75, No.8 (2020), 623-631. doi:10.1136/thoraxjnl-2019-214355 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/58048
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Title
Mucoactive agents for acute respiratory failure in the critically ill: A systematic review and meta-analysis
Other Contributor(s)
Faculty of Biology, Medicine and Health
Oxford University Hospitals NHS Foundation Trust
Bristol Royal Infirmary
Queen's University Belfast
University of Melbourne
Ulster University
Mahidol University
Nuffield Department of Medicine
Guy's and St Thomas' NHS Foundation Trust
Universiteit van Amsterdam
Oxford University Hospitals NHS Foundation Trust
Bristol Royal Infirmary
Queen's University Belfast
University of Melbourne
Ulster University
Mahidol University
Nuffield Department of Medicine
Guy's and St Thomas' NHS Foundation Trust
Universiteit van Amsterdam
Abstract
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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.