Meta AnalysisID 7219
硫酸镁和/或钙通道阻滞剂作为辅助解毒剂用于急性有机磷化合物中毒标准治疗：系统评价与Meta分析
CRD42023484495
This systematic review aims to evaluate the data available to date on the safety and efficacy of intravenous magnesium sulfate (MgSO4) and/ or calcium channel blockers (CCB) compared with standard therapy for the treatme
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Record Fields
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- Meta Analysis Id
- 7219
- Evidence Id
- 15777
- Core Evidence Id
- 15777
- Source Meta Analysis Id
- 7206
- Herb2 Meta Analysis Id
- HBMA007206
- Crd Id
- CRD42023484495
- Title
- Magnesium sulfate and/or calcium blockers as coadjuvant antidotes to standard therapy for acute organophosphate compound poisoning: a systematic review and meta-analysis
- Review Question
- This systematic review aims to evaluate the data available to date on the safety and efficacy of intravenous magnesium sulfate (MgSO4) and/ or calcium channel blockers (CCB) compared with standard therapy for the treatment of people with acute OP poisoning. We hypothesize that MgSO4 and/or CCB are effective and safe strategies as coadjuvant of standard therapy in organophosphate compounds (OP) poisoning. This review will be prepared following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, PRISMA. The research question will be structured according to the PICOT criteria. -Patients: Any person with symptomatic acute OP poisoning. -Interventions: intravenous MgSO4 and/or CCB (amlodipine, nifedipine, nimodipine, nitrendipine, verapamil, or diltiazem) administered after hospital admission, at any dose schedule throughout the hospital length (for at least 24 hrs) -Comparison: placebo, atropine, oximes, and any other pharmacotherapy and/or standard care available for the treatment of people with acute OP poisoning -Outcomes: .Primary outcomes Mortality: percentage of death and survival within each group .Secondary outcomes: a) Length of hospital stays: mean of total hospital or ICU stay (hours); b) Need of mechanical ventilation: number of patients requiring of invasive mechanical ventilation; c) Atropine requirement: mean of total atropine (mg); d) Adverse Events (AEs) due to the interventions. -Time: we plan to include randomized controlled trials (RCTs) of at least 4 weeks of overall study
- Study Type Included
- We will include only randomized controlled trials (RCTs) of at least 4 weeks of the overall study -Inclusion criteria: articles with original data from RCT examining the use of MgSO4 and/ or CCB for treating people with OP poisoning. The search won`t be restricted by language or status of publication -Exclusion criteria: a) repetitive data; b) old published data for the same study; c) unavailability of the complete report for reference in case of lack of clarity of information in the abstract; d) Case series; e) Case reports; f) Nonsystematic reviews; g) Editorials; h) Letters to the editor
- Condition Being Studied
- The introduction of technologies such as pesticides in low and middle-income countries (LMIC), within the framework of an extractivist model, feeds a dynamic of dispossession of natural resources, territories, and therefore, of individuals and collective rights. The global number of deaths from pesticides has been estimated at approximately 100, 000 per year, predominantly in LMIC. Its incidence has decreased markedly over the past 20 years (from the previously estimated 200, 000 annual cases) probably due to its reduction in China. This is possibly due to internal migration from rural to urban areas, where these expositions are less frequent. However, most of these estimates have been based on data from hospital admissions, which would include only the most serious cases, with a notable underreporting of occupational exposures and ultimately their real impact on global community health. Organophosphorus compounds (OP) are pesticides that inhibit the carboxylic ester hydrolases, like acetylcholinesterase (AchE), an enzyme involved in the termination of cholinergic neurotransmission. Inhibition of this enzyme determines a rise in the concentration of acetylcholine (Ach) at the nerve junction, generating an overstimulation of muscarinic and nicotinic cholinergic receptors.
- Participant
- -Inclusion criteria: Any person with symptomatic acute OP poisoning. -Exclusion criteria: Studies that enrolled patients who presented with chronic OP exposure, concomitant exposition to other xenobiotics
- Animal
- Human Disease Modelled
- Intervention
- The use of intravenous magnesium sulfate (MgSO4) and/ or calcium channel blockers (CCB) as an adjuvant to standard therapy, has been described on a variable scale in the scientific literature to reduce hospitalization, morbidity, and mortality of acute OP poisoning. Magnesium sulfate is widely available in intensive care for different diseases such as the treatment of preeclampsia preventing eclamptic seizures, management of status asthmaticus, severe hypomagnesemia, or the torsades de pointes. Also, it`s an extremely economical intervention compared to oximes. A previous meta-analysis that included some randomized controlled trials (RCTs) suggested a benefit in terms of mortality and reduced length of stay in the intensive care unit. However, all trials were with MgSO4, had small sample sizes, poor quality, and generally high risk of bias, with a low level of certainty about the estimates of the treatment effect. -Inclusion criteria: intravenous MgSO4 and/or CCB (amlodipine, nifedipine, nimodipine, nitrendipine, verapamil, or diltiazem) administered after hospital admission, at any dose schedule throughout the hospital length (for at least 24 hrs) -Exclusion criteria: a) intravenous MgSO4 and/or CCB initiated before hospital admission or administered for less than 24 hours; b) any other specific antidote or advanced medical care before admission.
- Comparator Control
- The standard pharmacological therapy of OP poisoning involves antidotes such as atropine associated with oximes and has remained virtually unchanged for more than six decades. Atropine is a tropane alkaloid, which competitively antagonizes muscarinic receptors, with a parasympatholytic effect. Patients with severe symptoms require rapid atropinization, often in large doses, titrated to drying secretions (Unfortunately, the atropine does not counteract nicotinic symptoms, respiratory failure secondary to central inhibition or NMJ dysfunction, and invasive airway management may be necessary. Theoretically, oximes (i.e. pralidoxime, obidoxime, trimedoxime, or methoxime) reactivate AchE inhibited by OP. However, the available evidence has not substantially demonstrated the effectiveness of oximes and its usefulness is a matter of debate. Many authors still advocate the implementation of this therapy in severe cases or with nicotinic symptoms, as adjuvant of the atropine. -Inclusion criteria: placebo, atropine, oximes, and any other pharmacotherapy and/or standard care available for the treatment of people with acute OP poisoning -Exclusion criteria: No comparison; non-concordant historical controls
- Main Outcome
- Primary outcomes -Mortality: percentage of death and survival within each group (dichotommus) Measures of effect We will follow the intention-to-treat (ITT) principle, to assess the effect of intervention allocation, and maintain the benefit of the randomization, regardless of whether the interventions are received as intended. Dichotomous outcomes will be analyzed by risk ratio calculation (RR). We will calculate each summary measure’s corresponding confidence interval of 95% (IC 95%). As an absolute measure, the Number Needed to Treat (NNT) will be determined as the inverse of the Absolute Risk Reduction (1/ARR).
- Outcome Measure
- Additional Outcome
- Secondary outcomes: a) Length of hospital stays: mean of total hospital or ICU stay (hours); b) Need of mechanical ventilation: number of patients requiring of invasive mechanical ventilation; c) Atropine requirement: mean of total atropine (mg); d) Adverse Events (AEs) due to the interventions. Measures of effect Dichotomous outcomes will be analyzed by risk ratio calculation (RR), while for continuous outcomes we estimated the mean difference (MD). We calculate each summary measure’s corresponding confidence interval of 95% (IC 95%). We will use the standardized mean difference (SMD) when studies use different instruments. We consider the possibility and implications of skewed data when analyzing continuous outcomes, particularly in small sample trials, where the true distribution may be asymmetrical
- Study Method
- Meta-analysis, Systematic review
- Keyword
- MeSH headings have not been applied to this record
- Contact
- Omar De Santi [email protected]
- Organisational Affiliation
- Hospital Nacional Profesor Alejandro Posadas-Centro Nacional de Intoxicaciones (CNI) https://www.argentina.gob.ar/salud/hospital-nacional-posadas/intoxicaciones
- Funding Source
- The authors declare no funding for this research.
- Other Selection Criteria
- Final Publication
- Same Topic Review
- Published Protocol
- Review Type
- Language
- English
- Country
- Argentina
- Review Stage
- Review Ongoing
- First Submission Date
- 2023-11-20
- Registration Date
- 2023-12-03
- Anticipated Start Date
- 2024-01-01
- Anticipated Completion Date
- 2024-09-10
- Title Cn
- 硫酸镁和/或钙通道阻滞剂作为辅助解毒剂用于急性有机磷化合物中毒标准治疗：系统评价与Meta分析
- Title En
- Magnesium sulfate and/or calcium blockers as coadjuvant antidotes to standard therapy for acute organophosphate compound poisoning: a systematic review and meta-analysis
- Bilingual Status
- complete