Comparative Outcomes of different interventions in ARDS: A systematic review and network meta-analysis Article Swipe
Zhiyuan Xu
,
Haonan Liu
,
Shuaishuai Zhou
,
Ruiqi Zhang
,
Chao Meng
,
Shengli Li
,
Xiao Liu
,
Xianliang Yan
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.21203/rs.3.rs-2439237/v1
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.21203/rs.3.rs-2439237/v1
OBJECTIVES: Acute respiratory distress syndrome (ARDS) is linked to high rates of morbidity and mortality. Evidence examining commonly used corticosteroids, neuromuscular blocking agents (NMBAs) and inhaled nitric oxide (iNO) remains uncertain. The aim of the study was to compare and rank these three treatments to identify the best one. DATA SOURCES: We searched Pubmed, Embase, Cochrane Library, and Web of Science from the earliest records to May 1, 2022 for clinic trials. STUDY SELECTIONT AND DATA EXTRACTION: Clinical trials of three interventions compared with control group for ARDS, no language restricted. Data were extracted by 2 independent reviewers. Frequentist network meta-analyses (NMA) were performed to identify the best intervention and treatments were ranked using the surface under the cumulative ranking (SUCRA) curve. Primary outcome was 28-day mortality. Secondary outcomes varied ventilator-free days at 28 days, ICU mortality, In-hospital mortality and new infection events. DATA SYNTHESIS: Data were combined from 26 clinical trials which included 5071 patients. Vecuronium bromide was the best strategy to reduce 28-day mortality compared with the conventional treatment, iNO, methylprednisolone and placebo (OR 0.38, 95% CI 0.15-1.00 and OR 0.30, 95% CI 0.10-0.85 and OR 0.25, 95% CI 0.08-0.74 and OR 0.23, 95% CI 0.08-0.65; SUCRA: 96.6%). Dexamethasone was the best treatment option for increasing ventilator-free days at 28 days compared to conventional therapy and cisatracurium (MD 3.60, 95% CI 1.77-5.43 and MD 3.40, 95% CI 0.87-5.92; SUCRA: 93.2%). Methylprednisolone was the most effective treatment option to prevent ICU mortality (SUCRA: 88.5%). Though dexamethasone, cisatracurium, conventional therapy, methylprednisolone and iNO treatment showed no significant superiority of in-hospital mortality protection over placebo, suggesting that it had the highest probability of being the best treatment option (SUCRA: 79.7%) for reducing in-hospital mortality. Dexamethasone treatment showed the highest safety for decreasing the incidence of new infection events compared with placebo and iNO (OR 0.61, 95% CI 0.42-0.88 and OR 0.33, 95% CI 0.19-0.58; SUCRA: 91.8%). Conclusions : This NMA suggested that corticosteroids are possibly beneficial in the patients with ARDS while application of NMBAs may reduce 28-day mortality, iNO as a therapeutic measure which did not show a prominent beneficial effect. Study registration: PROSPERO, CRD42022333165
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.21203/rs.3.rs-2439237/v1
- https://www.researchsquare.com/article/rs-2439237/latest.pdf
- OA Status
- green
- References
- 59
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4319337867
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4319337867Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.21203/rs.3.rs-2439237/v1Digital Object Identifier
- Title
-
Comparative Outcomes of different interventions in ARDS: A systematic review and network meta-analysisWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-02-07Full publication date if available
- Authors
-
Zhiyuan Xu, Haonan Liu, Shuaishuai Zhou, Ruiqi Zhang, Chao Meng, Shengli Li, Xiao Liu, Xianliang YanList of authors in order
- Landing page
-
https://doi.org/10.21203/rs.3.rs-2439237/v1Publisher landing page
- PDF URL
-
https://www.researchsquare.com/article/rs-2439237/latest.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
-
https://www.researchsquare.com/article/rs-2439237/latest.pdfDirect OA link when available
- Concepts
-
Medicine, ARDS, Meta-analysis, Randomized controlled trial, Cochrane Library, Internal medicine, Placebo, Intensive care medicine, Lung, Pathology, Alternative medicineTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- References (count)
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59Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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