<i>The Cochrane Library</i> and the Treatment of Bronchiolitis in Children: An Overview of Reviews
Notice bibliographique
Résumé
Abstract Background Bronchiolitis describes a viral inflammation of the bronchioles in the lower respiratory tract that is typically caused by infection with respiratory syncytial virus (RSV). Bronchiolitis is characterized by high morbidity and affects approximately one in three infants. Children are currently treated with a variety of therapies that may be ineffective or even harmful; potential therapies include antibiotics, bronchodilators, chest physiotherapy, epinephrine, extrathoracic pressure, glucocorticoids, heliox, hypertonic saline, immunoglobulin, inhaled corticosteroids and oxygen therapy. Objectives This updated overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the effectiveness and safety of 11 pharmacologic and non‐pharmacologic treatments to improve bronchiolitis symptoms in outpatient, inpatient and intensive care populations. Methods The CDSR was searched using the term ‘bronchiolitis’ restricted to the title, abstract or keywords for all systematic reviews examining pharmacologic or non‐pharmacologic interventions for the treatment of bronchiolitis in infants and children. Data were extracted, complied into tables, and synthesized using qualitative and quantitative methods. Main Results For outpatients with bronchiolitis (defined as the first episode of wheezing in children under two), nebulized epinephrine decreased hospitalization rate on day one by 33% (RR: 0.67; 95% CI: 0.50, 0.89; 4 trials; 920 participants). With the addition of glucocorticoids, there was a reduction of similar magnitude for hospitalization rate within seven days (RR: 0.65; 95% CI: 0.44, 0.95; 1 trial; 400 participants). For inpatients, nebulized epinephrine versus bronchodilator and 3% hypertonic saline versus 0.9% saline each decreased length of stay: epinephrine decreased length of stay by seven hours (MD: − 0.28; 95% CI: − 0.46, − 0.09; 4 trials; 261 participants), and 3% hypertonic saline decreased length of stay by 28 hours (MD: − 1.16; 95% CI: − 1.55, − 0.77; 4 trials; 282 participants). Outpatients treated with epinephrine or epinephrine and glucocorticoid combined both had significantly lower clinical scores at 60 minutes (SMD: − 0.45; 95% CI: − 0.66, − 0.23; 4 trials; 900 participants, and SMD: − 0.34; 95% CI: − 0.54, − 0.14; 1 trial; 399 participants). For inpatients, epinephrine versus bronchodilator led to a significantly lower clinical score at both 60 minutes (SMD: − 0.79; 95% CI: − 1.45, − 0.13; 4 trials; 248 participants; I 2 : 79%) and 120 minutes (SMD: − 0.52; 95% CI: − 0.86, − 0.18; 1 trial; 140 participants). Inpatients treated with chest physiotherapy or 3% hypertonic saline both had significantly lower clinical scores at 1–3 days (SMD: − 0.55; 95% CI: − 0.98, − 0.12; 1 trial; 87 participants, and SMD: − 0.84; 95% CI: − 1.39, − 0.30; 3 trials; 183 participants). Authors' Conclusions For outpatients with bronchiolitis, nebulized epinephrine can be effective in avoiding hospitalization. Systemic glucocorticoids such as dexamethasone cannot be recommended as a routine therapy given the current level of evidence and potential for adverse events. For inpatients, regular nebulized hypertonic saline (3%) driven using oxygen may reduce the length of hospital stay. Chest physiotherapy, nebulized epinephrine and systemic and inhaled glucocorticoids cannot be recommended for inpatients given the weak level of evidence. For the sickest of patients in the intensive care unit, intravenous immunoglobulin, helium‐oxygen mixtures (heliox) and extrathoracic pressure cannot be recommended due to lack of available evidence and/or methodological flaws of reviews. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».