GADE and summary of findings
| Summary of findings: mucoactive agents compared with non-mucoactive agents for acute respiratory failure | |||||
| Patient or population: ventilated with acute respiratory failure Setting: intensive care unit (ICU) Intervention: mucoactive agents Comparison: non-mucoactive agents | |||||
| Outcomes | № of participants (studies) Follow-up | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects | |
| Risk with non-mucoactives | Risk difference with mucoactives | ||||
| Duration of ventilation | 1226 (7 RCTs) | ⨁◯◯◯ VERY LOW* | – | The mean duration of Ventilation was 0 | MD 1.34 lower (2.97 lower to 0.29 higher) |
| Mortality | 1428 (12 RCTs) | ⨁⨁⨁◯ MODERATE† |
OR 0.75
(0.52 to 1.08) | 336 per 1000 | 61 fewer per 1000 (128 fewer to 17 more) |
| Duration of ICU stay | 1362 (10 RCTs) | ⨁◯◯◯ VERY LOW‡ | – | The mean duration of ICU stay was 0 | MD 3.22 lower (5.49 lower to 0.96 lower) |
| Duration of hospital stay | 1067 (4 RCTs) | ⨁◯◯◯ VERY LOW§ | – | The mean duration of Hospital stay was 0 | MD 2.05 lower (5.87 lower to 1.76 higher) |
| Ventilator free days at day 28 | 785 (2 RCTs) | ⨁◯◯◯ VERY LOW¶ | – | The mean ventilator-free days at day 28 was 0 | MD 2.35 higher (1.76 lower to 6.45 higher) |
GRADE working group grades of evidence: High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
*Risk of bias was deemed serious as the majority of trials (6/7) had an unclear or high risk of bias in at least one domain. Inconsistency was deemed as very serious due to high heterogeneity (I2=82%).
†Risk of bias was deemed serious as the majority of trials (11/12) had an unclear or high risk of bias in at least one domain.
‡Risk of bias was deemed serious as the majority of trials (9/10) had an unclear or high risk of bias in at least one domain. Inconsistency was deemed as very serious due to high heterogeneity (I2=89%).
§Risk of bias was deemed serious as the majority of trials (3/4) had an unclear or high risk of bias in at least one domain. Inconsistency was deemed as very serious due to high heterogeneity (I2=81%).
¶Risk of bias was deemed serious as both trials (2/2) had an unclear or high risk of bias in at least one domain. Inconsistency was deemed as very serious due to high heterogeneity (I2=77%).
GRADE, Grades of Recommendation, Assessment, Development and Evaluation; MD,mean difference.