Continuous positive airway pressure (CPAP) for acute bronchiolitis in children
Kana R Jat, Jeanne M Dsouza, Joseph L Mathew
The use of Continuous Positive Airway Pressure did not reduce the need for mechanical ventilation in children with bronchiolitis, although the evidence was of low certainty. Limited, low certainty evidence suggests that breathing improved (a decreased respiratory rate) in children with bronchiolitis who received CPAP. Larger, adequately powered trials are needed to evaluate the effect of CPAP for children with acute bronchiolitis.
Inhaled corticosteroids for the treatment of COVID‐19
Mirko Griesela, Carina Wagnera, Agata Mikolajewska, Miriam Stegemann, Falk Fichtner, Maria-Inti Metzendorf, Avinash Anil Nair, Jefferson Daniel, Anna-Lena Fischera, Nicole Skoetz
In people with confirmed COVID‐19 and mild symptoms who are able to use inhaler devices, we found moderate‐certainty evidence that inhaled corticosteroids probably reduce the combined endpoint of admission to hospital or death and increase the resolution of all initial symptoms at day 14. Low‐certainty evidence suggests that corticosteroids make little to no difference in all‐cause mortality up to day 30 and may decrease the duration to symptom resolution. There is low‐certainty evidence that inhaled corticosteroids may decrease infections.
The evidence we identified came from studies in high‐income settings using budesonide and ciclesonide prior to vaccination roll‐outs.
Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease
Han Ni, Swe Zin Aye, Cho Naing
Intravenous magnesium sulfate may be associated with fewer hospital admissions, reduced length of hospital stay and improved dyspnoea scores compared to placebo.
For nebulised magnesium sulfate, we are unable to draw conclusions about its effects in Chronic Obstructive Pulmonary Disease exacerbations for most of the outcomes.
Magnetic Resonance Imaging (MRI) for diagnosis of acute appendicitis
Nigel D'Souza, Georgina Hicks, Richard Beable, Antony Higginson, Bo Rud
Magnetic Resonnace Imaging appears to be highly accurate in confirming and excluding acute appendicitis in adults, children, and pregnant women regardless of protocol. The methodological quality of the included studies was generally low.
Oxygenation during the apnoeic phase preceding intubation in adults in prehospital, emergency department, intensive care and operating theatre environments
Leigh D White, Ruan A Vlok, Christopher YC Thang, David H Tian, Thomas M Melhuish
There was some evidence that oxygenation during the apnoeic phase of intubation may improve the lowest recorded oxygen saturation. However, the differences in oxygen saturation were unlikely to be clinically significant.
SARS‐CoV‐2‐neutralising monoclonal antibodies to prevent COVID‐19
Caroline Hirsch, Yun Soo Park, Vanessa Piechotta, Khai Li Chai, Lise J Estcourt, Ina Monsef, Susanne Salomon, Erica M Wood, Cynthia So-Osman, Zoe McQuilten, Christoph D Spinner, Jakob J Malin, Miriam Stegemann, Nicole Skoetz, Nina Kreuzberger
For Pre Exposure Prophilaxis, there is a decrease in development of clinical COVID‐19 symptoms (high certainty), infection with SARS‐CoV‐2 (moderate certainty), and admission to hospital (low certainty) with tixagevimab/cilgavimab. There is low certainty of a decrease in infection with SARS‐CoV‐2, and development of clinical COVID‐19 symptoms; and a higher rate for all‐grade AEs with casirivimab/imdevimab.
For Post Exposure Prophylaxis, there is moderate certainty of a decrease in infection with SARS‐CoV‐2 and low certainty for a higher rate for all‐grade AEs with bamlanivimab. There is high certainty of a decrease in infection with SARS‐CoV‐2, development of clinical COVID‐19 symptoms, and a higher rate for all‐grade AEs with casirivimab/imdevimab.
These findings only apply to people unvaccinated against COVID‐19 and to the variants prevailing during the study and not other variants (e.g. Omicron).
Training healthcare providers (HCP) to respond to intimate partner violence against women (IPV)
Naira Kalra, Leesa Hooker, Sonia Reisenhofer, Gian Luca Di Tanna, Claudia García-Moreno
Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self‐perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories.
Transfusion thresholds for guiding red blood cell transfusion (RBC)
Jeffrey L Carsona, Simon J Stanwortha, Jane A Dennisa, Marialena Trivella, Nareg Roubinian, Dean A Fergusson, Darrell Triulzi, Carolyn Dorée, Paul C Hébert
Transfusion at a restrictive haemoglobin concentration decreased the proportion of people exposed to RBC transfusion by 41% across a broad range of clinical contexts. Across all trials, no evidence suggests that a restrictive transfusion strategy impacted 30‐day mortality, mortality at other time points, or morbidity (i.e. cardiac events, myocardial infarction, stroke, pneumonia, thromboembolism, infection) compared with a liberal transfusion strategy.
Some patient subgroups might benefit from RBCs to maintain higher haemoglobin concentrations; research efforts should focus on these clinical contexts.
Ultrasound guidance for arterial (other than femoral) catheterisation in adults
Ronald LG Flumignan, Virginia FM Trevisani, Renato D Lopes, Jose CC Baptista-Silva, Carolina DQ Flumignan, Luis CU Nakano
Real‐time B‐mode ultrasound guidance may improve first attempt success rate, overall success rate, and time needed for a successful procedure for radial artery catheterisation compared to palpation, or Doppler Auditory Ultrasound AssistanceA. In addition, real‐time B‐mode ultrasound guidance probably decreases major haematomas compared to palpation. However, we are uncertain about the evidence on major haematomas and pain for other comparisons due to very low‐certainty evidence and unreported outcomes. We are also uncertain about the effects on pseudoaneurysm and QoL for axillary and dorsalis pedis arteries catheterisation.
Ultrasound guidance versus landmark method for peripheral venous cannulation in adults
Masafumi Tada, Naoki Yamada, Takashi Matsumoto, Chikashi Takeda, Toshi A Furukawa, Norio Watanabe
There is very low‐ and low‐certainty evidence that, compared to the landmark method, ultrasound guidance may benefit difficult participants for increased first‐pass and overall success of cannulation, with no difference detected in pain. There is moderate‐ and low‐certainty evidence that, compared to the landmark method, ultrasound guidance may benefit moderately difficult participants due to a small increased first‐pass success of cannulation with no difference detected in pain. There is moderate‐ and high‐certainty evidence that, compared to the landmark method, ultrasound guidance does not benefit easy participants: ultrasound guidance decreased the first‐pass success of cannulation with no difference detected in overall success of cannulation and increased pain.
Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation
Jan Hansel, Andrew M Rogers, Sharon R Lewis, Tim M Cook, Andrew F Smith
Video Laryngoscopies (VL) of all designs likely reduce rates of failed intubation and result in higher rates of successful intubation on the first attempt with improved glottic views. Macintosh‐style and channelled VLs likely reduce rates of hypoxaemic events, while hyperangulated VLs probably reduce rates of oesophageal intubation. VL likely provides a safer risk profile compared to direct laryngoscopy for all adults undergoing tracheal intubation.
Ultrasound‐guided arterial cannulation in the paediatric population
Christian K Raphael, Nour A El Hage Chehade, Joanne Khabsa, Elie A Akl, Marie Aouad-Maroun, Roland Kaddoum
We identified moderate‐certainty evidence that ultrasound guidance for arterial cannulation compared with palpation or Doppler auditory assistance improves first‐attempt success rate, second‐attempt success rate and overall success rate. We also found moderate‐certainty evidence that ultrasound guidance reduces the incidence of complications, the number of attempts to successful cannulation and the duration of the cannulation procedure.
Family presence during resuscitation
Monika Afzali Rubin, Tintin LG Svensson, Suzanne Forsyth Herling, Patricia Jabre, Ann Merete Møller
There was insufficient evidence to draw any firm conclusions on the effects of family présence during resuscitation on relatives' psychological outcomes.
Sufficiently powered and well‐designed randomized controlled trials may change the conclusions of the review in future.
Hypothermia for neuroprotection in adults after cardiac arrest
Jasmin Arrich, Nikola Schütz, Julia Oppenauer, Janne Vendt, Michael Holzer, Christof Havel, Harald Herkner
Current evidence suggests that conventional cooling methods to induce therapeutic hypothermia may improve neurological outcomes after cardiac arrest. We obtained available evidence from studies in which the target temperature was 32 °C to 34 °C.
Oxygenation during the apnoeic phase preceding intubation in adults in prehospital, emergency department, intensive care and operating theatre environments
Leigh D White, Ruan A Vlok, Christopher YC Thang, David H Tian, Thomas M Melhuish
There was some evidence that oxygenation during the apnoeic phase of intubation may improve the lowest recorded oxygen saturation. However, the differences in oxygen saturation were unlikely to be clinically significant. This did not translate into any measurable effect on the incidence of hypoxaemia or severe hypoxaemia in a group of predominately critically ill people. We were unable to assess the influence on hospital length of stay; however, there was a reduction in ICU stay in the apnoeic oxygenation group. The mechanism for this is unclear as there was little to no difference in first pass success or adverse event rates.
Higher versus lower fractions of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit
Thomas L Klitgaard, Olav L Schjørring, Frederik M Nielsen, Christian S Meyhoff, Anders Perner, Jørn Wetterslev, Bodil S Rasmussen, Marija Barbateskovic
In adult ICU patients, it is still not possible to draw clear conclusions about the effects of higher versus lower oxygenation strategies on all‐cause mortality, serious adverse events, quality of life, lung injuries, myocardial infarction, stroke, and sepsis at maximum follow‐up. This is due to low or very low‐certainty evidence.
Extracorporeal membrane oxygenation for critically ill adults
Aidan Burrell, Jiwon KimPatricia Alliegro, Lorena Romero, Ary Serpa Neto, Frederick Mariajoseph, Carol Hodgson
In this updated systematic review, which included four additional randomized controlled trials, we found that extracorporeal membrane oxygenation was associated with a reduction in day‐90 to one‐year all‐cause mortality, as well as three times increased risk of bleeding. However, the certainty of this result was only low to moderate, limited by a low number of small trials, clinical heterogeneity, and indirectness across studies.
