Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
Department of Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
Emerg Med J. 2023 Sep;40(9):660-665. doi: 10.1136/emermed-2022-212871. Epub 2023 Apr 19.
Nausea and vomiting is a common ED chief complaint. However, randomised trials comparing antiemetic agents to placebo have not demonstrated superiority. This systematic review investigates the efficacy of inhaled isopropyl alcohol (IPA) compared with usual care or placebo in adults presenting to the ED with nausea and vomiting.
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, other relevant trial registries, journals, and conference proceedings up to September 2022. Randomised controlled trials using IPA to treat adult ED patients with nausea and vomiting were included. The primary outcome was change in severity of nausea, measured by a validated scale. A secondary outcome was vomiting during the ED stay. We used a random-effects model for the meta-analysis, and assessed certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation system.
Two trials comparing inhaled IPA to saline placebo and including a total of 195 patients were pooled for meta-analysis of the primary outcome. A third study comparing a group receiving inhaled IPA and oral ondansetron to another group receiving inhaled saline placebo and oral ondansetron did not qualify for the original registered protocol, but was included in a secondary analysis. All studies were judged to be at low or unclear risk of bias. The pooled mean difference for the primary analysis was a reduction in reported nausea of 2.18 on a 0-10 scale (95% confidence interval (CI) 1.60 to 2.76), favouring IPA over placebo, where the minimum clinically significant difference was defined as 1.5. The evidence level was graded as moderate, due to imprecision from low patient numbers. Only the study included in the secondary analysis assessed the secondary outcome of vomiting, and did not find a difference between intervention and control.
This review suggests that IPA likely has a modest effect in reducing nausea in adult ED patients, compared with placebo. Larger multicentre trials are needed, as the evidence is limited by few trials and patients.
CRD42022299815.
恶心和呕吐是急诊科常见的主要诉求。然而，比较止吐药物与安慰剂的随机试验并未显示出优势。本系统评价调查了与常规护理或安慰剂相比，吸入异丙醇（IPA）在急诊科因恶心和呕吐就诊的成人中的疗效。
我们检索了 MEDLINE、Embase、Cochrane 对照试验中心注册库、其他相关试验注册库、期刊和会议记录，截至 2022 年 9 月。纳入使用 IPA 治疗急诊科因恶心和呕吐就诊的成年患者的随机对照试验。主要结局是通过验证量表测量的恶心严重程度变化。次要结局是急诊科留观期间呕吐。我们使用随机效应模型进行荟萃分析，并使用推荐、评估、制定和评估系统评估证据确定性。
两项比较吸入 IPA 与盐水安慰剂的试验共纳入 195 例患者，可进行主要结局的荟萃分析。第三项研究比较了一组接受吸入 IPA 和口服昂丹司琼与另一组接受吸入生理盐水安慰剂和口服昂丹司琼的患者，该研究不符合原始注册方案，但包含在二次分析中。所有研究均被认为具有低风险或不确定风险的偏倚。主要分析的汇总平均差异为报告的恶心程度降低 2.18（0-10 分制；95%置信区间 1.60 至 2.76），IPA 优于安慰剂，其中最小临床显著差异定义为 1.5。证据水平被评为中等，因为患者数量少导致结果不精确。只有纳入二次分析的研究评估了干预和对照组之间的次要结局呕吐，未发现差异。
本综述表明，与安慰剂相比，IPA 可能在减轻急诊科成年患者的恶心方面有一定效果。需要更大规模的多中心试验，因为证据有限，且患者数量较少。
PROSPERO 注册号：CRD42022299815。
