Researchers urge caution in the use of mucoactive agents in patients with acute respiratory failure (ARF).
Published in Thorax, a systematic review and meta-analysis by Queen’s University Belfast, Oxford University and others examined trials of adults receiving ventilatory support for ARF and involving at least one mucoactive agent compared with placebo or standard care.
The researchers searched electronic and grey literature up to January 2020. Two reviewers independently screened, selected, extracted data and quality assessed studies. Outcomes included duration of mechanical ventilation. Meta-analysis was undertaken using random-effects modelling and certainty of the evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation.
A total of 13 randomised controlled trials were included (1712 patients), investigating four different mucoactive agents. Mucoactive agents showed no effect on duration of mechanical ventilation (seven trials; mean difference [MD], −1.34; 95% CI, −2.97 to 0.29; I2=82%; very low certainty) or mortality, hospital stay and ventilator-free days.
There was an effect on reducing intensive care unit length of stay in the mucoactive agent groups (10 trials; MD, −3.22, 95% CI, −5.49 to −0.96; I2=89%; very low certainty).
The authors concluded that the findings do not support the use of mucoactive agents in critically ill patients with ARF, although they acknowledge that the existing evidence is of low quality. They say high-quality randomised controlled trials are needed to determine the role of specific mucoactive agents in critically ill patients with ARF.