Abushanab Dina Hamdi, Alsoukhni Omar Adnan, Al-Badriyeh Daoud
Pharmacy Department, Hamad Medical Corporation, Doha, Qatar; College of Pharmacy, Qatar University, Doha, Qatar.
Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
Value Health Reg Issues. 2019 Sep;19:7-25. doi: 10.1016/j.vhri.2018.11.001. Epub 2019 Jan 8.
Mechanically ventilated patients with respiratory disorders may require sedatives, such as opioids.
To define methodological trends, gaps, and the reporting quality of the comparative clinical and economic evaluations of fentanyl and morphine in ventilated patients in the intensive care unit.
We conducted a literature review of the MEDLINE, Embase, OVID, ScienceDirect, Springer Link, and EconLit databases, comparing studies in the management of ventilated patients with respiratory disorders in the intensive care unit using either fentanyl or morphine, or both. We assessed the methodological aspects of the literature characteristics and trends of, for example, modeling, data sources, cost calculation, and data analysis, appraising the quality of reporting via the CONsolidated Standards Of Reporting Trials, STrengthening the Reporting of OBservational studies in Epidemiology, and the Consolidated Health Economic Evaluation Reporting Standards checklists.
Among 1327 articles, 33 (comprising 22 in adults, 8 in neonates, and 3 in pediatrics) met the inclusion criteria. No head-to-head morphine versus fentanyl evaluations explicitly confined to subjects with respiratory conditions were undertaken. Studies relied on various scales to measure the sedation level as a primary study outcome, limiting the comparability of study conclusions. Seven articles of adults were identified to be economic studies from the hospital perspective. On the basis of different endpoints, the same sedation regimen performed differently in various studies. None of the randomized controlled trials, observational cohorts, or pharmacoeconomics studies met most of the assessed reporting quality criteria.
Our review identified poor reporting quality and high heterogeneity of methods used, potentially limiting the degree to which studies could be interpreted, decisions could be influenced, and findings could be generalized.
患有呼吸系统疾病的机械通气患者可能需要使用镇静剂，如阿片类药物。
明确重症监护病房中使用芬太尼和吗啡对通气患者进行比较临床和经济评估的方法学趋势、差距及报告质量。
我们对MEDLINE、Embase、OVID、ScienceDirect、Springer Link和EconLit数据库进行了文献综述，比较了在重症监护病房中使用芬太尼或吗啡或两者对患有呼吸系统疾病的通气患者进行管理的研究。我们评估了文献特征的方法学方面以及建模、数据来源、成本计算和数据分析等趋势，通过《报告试验的统一标准》、《加强流行病学观察性研究报告》和《卫生经济评估报告标准合并清单》来评估报告质量。
在1327篇文章中，33篇（包括22篇成人研究、8篇新生儿研究和3篇儿科研究）符合纳入标准。没有进行明确仅限于患有呼吸系统疾病受试者的吗啡与芬太尼的直接比较评估。研究依赖于各种量表来测量镇静水平作为主要研究结果，限制了研究结论的可比性。从医院角度确定了7篇成人经济研究文章。基于不同的终点，相同的镇静方案在不同研究中的表现不同。没有一项随机对照试验、观察性队列研究或药物经济学研究符合大多数评估的报告质量标准。
我们的综述发现报告质量较差且所用方法的异质性较高，这可能限制了研究结果的解释程度、对决策的影响程度以及研究结果的推广程度。
