Abstract:Introduction
Bronchiolitis is common reason for infant hospitalization. The aim of our systematic review and meta‐analysis was to evaluate helium–oxygen (heliox) in bronchiolitis.
Methods
We screened 463 studies, assessed 22 of them, and included six randomized controlled trials. Primary outcomes were the need for continuous positive airway pressure (CPAP) or intubation, hospitalization duration, and change in the modified Woods Clinical Asthma Scale (M‐WCAS). We calculated mean differences with 95% confidence… Show more
“…2 Several inhaled treatments have been proposed to acute bronchiolitis, for example hypertonic saline, racemic norephedrine, salbutamol and helium-oxygen and so forth, but none of these has proven to be effective in meta-analyses. [3][4][5][6] A novel treatment with nitric oxide was reported to reduce length of hospital stay in acute bronchiolitis infants in two small trials. 7,8 Inhaled nitric oxide has been stated to have potential as anti-inflammatory and antiviral agent.…”
ObjectiveUntil date there is lack of effective therapies in acute bronchiolitis in infants. The aim was to analyze inhaled nitric oxide efficacy in acute bronchiolitis.DesignSystematic review and meta‐analysis of randomized controlled trials.SettingPediatric specialized healthcare.PatientsAll infants (age less than 2 years) having acute bronchiolitis, which requires emergency room visit or hospitalization.InterventionInhaled nitric oxide.Main Outcome MeasuresNeed for intensive care unit admission. Secondary outcomes were length of hospital stay and adverse events. Risk ratios (RR) and mean differences with 95% confidence intervals (CI) calculated by random‐effects DerSimonian and Laird inverse variance method. Peto Odds ratios were used for rare outcomes. Evidence certainty assessed according to GRADE.Results186 studies were screened and three included for analysis. Two had low risk of bias and one had some concerns. Three studies (166 infants) analyzed length of hospital stay and the duration was −11.3 h (CI: −26.8 to +4.2 h) shorter in the nitric oxide group. Evidence certainty was ranked as low. Overall adverse event rates were similar (3 studies, 166 infants, RR: 0.94, CI: 0.70–1.26), but treatment related harms were more common in nitric oxide group (2 studies, 98 infants, OR: 3.86, CI: 1.04–14.40). Evidence certainty in both was rated as low.ConclusionsLow certainty evidence suggests that inhaled nitric oxide does not reduce length of hospital stay but may have higher rate of treatment associated harms. Future studies with larger sample sizes are needed to better estimate both the efficacy and adverse events.
“…2 Several inhaled treatments have been proposed to acute bronchiolitis, for example hypertonic saline, racemic norephedrine, salbutamol and helium-oxygen and so forth, but none of these has proven to be effective in meta-analyses. [3][4][5][6] A novel treatment with nitric oxide was reported to reduce length of hospital stay in acute bronchiolitis infants in two small trials. 7,8 Inhaled nitric oxide has been stated to have potential as anti-inflammatory and antiviral agent.…”
ObjectiveUntil date there is lack of effective therapies in acute bronchiolitis in infants. The aim was to analyze inhaled nitric oxide efficacy in acute bronchiolitis.DesignSystematic review and meta‐analysis of randomized controlled trials.SettingPediatric specialized healthcare.PatientsAll infants (age less than 2 years) having acute bronchiolitis, which requires emergency room visit or hospitalization.InterventionInhaled nitric oxide.Main Outcome MeasuresNeed for intensive care unit admission. Secondary outcomes were length of hospital stay and adverse events. Risk ratios (RR) and mean differences with 95% confidence intervals (CI) calculated by random‐effects DerSimonian and Laird inverse variance method. Peto Odds ratios were used for rare outcomes. Evidence certainty assessed according to GRADE.Results186 studies were screened and three included for analysis. Two had low risk of bias and one had some concerns. Three studies (166 infants) analyzed length of hospital stay and the duration was −11.3 h (CI: −26.8 to +4.2 h) shorter in the nitric oxide group. Evidence certainty was ranked as low. Overall adverse event rates were similar (3 studies, 166 infants, RR: 0.94, CI: 0.70–1.26), but treatment related harms were more common in nitric oxide group (2 studies, 98 infants, OR: 3.86, CI: 1.04–14.40). Evidence certainty in both was rated as low.ConclusionsLow certainty evidence suggests that inhaled nitric oxide does not reduce length of hospital stay but may have higher rate of treatment associated harms. Future studies with larger sample sizes are needed to better estimate both the efficacy and adverse events.
Introduction
Bronchiolitis is common reason for infant hospitalization. The aim of our systematic review and meta‐analysis was to evaluate helium–oxygen (heliox) in bronchiolitis.
Methods
We screened 463 studies, assessed 22 of them, and included six randomized controlled trials. Primary outcomes were the need for continuous positive airway pressure (CPAP) or intubation, hospitalization duration, and change in the modified Woods Clinical Asthma Scale (M‐WCAS). We calculated mean differences with 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes.
Results
Six studies (five double‐ and one single‐blinded) with 560 infants were included. The risk of bias was high in one, moderate in four, and low in one. The RR for the need for CPAP (three studies) was 0.87 (CI: 0.56–1.35), and for intubation (four studies) was 1.39 (CI: 0.53–3.63), heliox compared to air–oxygen. The hospital stay (four studies) was 0.25 days longer (CI: −0.22 to 0.71) in the heliox group. The mean decrease in M‐WCAS from the baseline (three studies) was 1.90 points (CI: 1.46–2.34) greater in the heliox group.
Conclusion
We found low‐quality evidence that heliox does not reduce the need for CPAP, intubation, or length of hospitalization for bronchiolitis. Based on the M‐WCAS scores, heliox seems to relieve respiratory distress symptoms rapidly after its initiation. The included studies had high heterogeneity in their methods and included relatively mild cases of bronchiolitis. A larger randomized controlled trial with more severe cases of bronchiolitis with enough power to analyze the need for intubation is needed in the future.
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