Cochrane · systematic review · CD004477
Pharmacological agents for adults with acute respiratory distress syndrome
Lewis, SR, Pritchard, MW, Thomas, CM, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Emergency and Critical CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
16
No studies
14
Included studies
NR
No studies 14 · 46.7%Ungraded 0 · 0%Very low 10 · 33.3%Low 3 · 10%Moderate 3 · 10%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Corticosteroids compared to control for adults with acute lung injury and acute respiratory distress syndrome
Population: adults with acute respiratory distress syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early all‐cause mortality (≤ 3 months) Reported at: day 14; day 28; day 60; and in hospital Corticosteroids vs control | RR 0.77 [0.57, 1.05] | 6 studies · 574 participants | Low Downgraded: risk of bias, imprecision |
Late all‐cause mortality ( > 3 months) Reported at: 180 days Corticosteroids vs control | RR 0.99 [0.64, 1.52] | 1 study · 180 participants | Very low Downgraded: risk of bias, imprecision |
Duration of mechanical ventilation Measured in days Corticosteroids vs control | no estimate extracted | 3 studies · 277 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Ventilator‐free days up to day 28 Corticosteroids vs control | no estimate extracted | 4 studies · 494 participants | Low Downgraded: imprecision, inconsistency |
Adverse events Defined as leading to discontinuation of study medication; or for studies with standard care control, defined by study authors as "serious adverse events" Corticosteroids vs control | no estimate extracted | NR | No studies |
Fitness to return to work at 12 months Corticosteroids vs control | no estimate extracted | NR | No studies |
Surfactants compared to control for adults with acute lung injury and acute respiratory distress syndrome
Population: adults with acute respiratory distress syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early all‐cause mortality (≤ 3 months) Reported at: 28 days; and 90 days. Time point not reported in 4 studies Surfactants vs control | RR 1.08 [0.91, 1.29] | 9 studies · 1338 participants | Very low Downgraded: risk of bias, inconsistency |
Late all‐cause mortality ( > 3 months) Reported at: 180 days Surfactants vs control | RR 1.28 [1.01, 1.61] | 1 study · 418 participants | Very low Downgraded: risk of bias, imprecision |
Duration of mechanical ventilation Measured in days Surfactants vs control | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Ventilator‐free days up to day 28 Surfactants vs control | no estimate extracted | 2 studies · 344 participants | Very low Downgraded: risk of bias, inconsistency |
Adverse events Defined as leading to discontinuation of study medication; data collected during study period Surfactants vs control | RR 0.5 [0.17, 1.44] | 2 studies · 88 participants | Very low Downgraded: risk of bias, imprecision |
Fitness to return to work at 12 months Surfactants vs control | no estimate extracted | NR | No studies |
N‐acetylcysteine compared to control for adults with acute lung injury and acute respiratory distress syndrome
Population: adults with acute respiratory distress syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early all‐cause mortality (≤ 3 months) Reported at: 30 days N‐acetylcysteine vs control | RR 0.64 [0.32, 1.3] | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Late all‐cause mortality ( > 3 months N‐acetylcysteine vs control | no estimate extracted | NR | No studies |
Duration of mechanical ventilation N‐acetylcysteine vs control | no estimate extracted | NR | No studies |
Ventilator‐free days up to day 28 N‐acetylcysteine vs control | no estimate extracted | NR | No studies |
Adverse events Defined as leading to discontinuation of study medication N‐acetylcysteine vs control | no estimate extracted | NR | No studies |
Fitness to return to work at 12 months N‐acetylcysteine vs control | no estimate extracted | NR | No studies |
Statins compared to control for adults with acute lung injury and acute respiratory distress syndrome
Population: adults with acute respiratory distress syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early all‐cause mortality (≤ 3 months) Reported at: 60 days; and during hospital stay Statins vs control | RR 0.99 [0.78, 1.26] | 3 studies · 1344 participants | Moderate Downgraded: inconsistency |
Late all‐cause mortality ( > 3 months Statins vs control | no estimate extracted | NR | No studies |
Duration of mechanical ventilation Measured in days Statins vs control | no estimate extracted | 1 study · 60 participants | Low Downgraded: imprecision |
Ventilator‐free days up to day 28 Statins vs control | no estimate extracted | 3 studies · 1342 participants | Moderate Downgraded: inconsistency |
Adverse events Defined as leading to discontinuation of study medication Statins vs control | no estimate extracted | NR | No studies |
Fitness to return to work at 12 months Statins vs control | no estimate extracted | NR | No studies |
Beta‐agonist compared to control for adults with acute lung injury and acute respiratory distress syndrome
Population: adults with acute respiratory distress syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early all‐cause mortality (≤ 3 months) Reported at: 28 days; 60 days; and during hospital stay Beta‐agonist vs control | RR 1.14 [0.91, 1.42] | 3 studies · 646 participants | Moderate Downgraded: imprecision |
Late all‐cause mortality (> 3 months Beta‐agonist vs control | no estimate extracted | NR | No studies |
Duration of mechanical ventilation Beta‐agonist vs control | no estimate extracted | NR | No studies |
Ventilator‐free days up to day 28 Beta‐agonist vs control | no estimate extracted | 3 studies · 646 participants | Very low Downgraded: imprecision, inconsistency |
Adverse events Defined as leading to discontinuation of study medication; data collected during study period Beta‐agonist vs control | no estimate extracted | 2 studies · 606 participants | Very low Downgraded: imprecision, inconsistency |
Fitness to return to work at 12 months Beta‐agonist vs control | no estimate extracted | NR | No studies |