Efficacy of interventions for bronchiolitis in critically ill infants: a systematic review and meta-analysis

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Caroline DavisonAdrienne G Randolph

Abstract

Viral bronchiolitis is the leading cause of respiratory failure among infants in the United States. Currently, the mainstay of treatment is supportive care. The effectiveness of treatments used for mechanically ventilated infants with bronchiolitis is unclear. To evaluate the strength of the evidence supporting the use of currently available treatments for critically ill infants with bronchiolitis. We searched PubMed, citations of relevant articles, personal files, and conference proceedings, and we contacted experts in the field. Randomized, controlled trials evaluating any therapy for bronchiolitis that included children in an intensive care unit. Two reviewers independently extracted data and assessed methodologic quality. A total of 2,319 citations were screened, and 16 randomized, controlled trials were included. There were three trials of surfactant, three of ribavirin, three of immune globulin, three of systemic corticosteroids, and one each of vitamin A, interferon, erythropoietin, and heliox. A meta-analysis of the three surfactant studies showed a strong trend toward a decrease in duration of mechanical ventilation of 2.58 days (95% confidence interval, -5.34 to 0.18 days; p =.07) and a significant decrease of 3.3 int...Continue Reading

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