anurajms/meta_analysis huggingface dataset:
primary outcome:
Intravenous nutrients for preventing inadvertent perioperative hypothermia in adults
Risk of hypothermia (mild, core temperature 35.0ºC to 35.9ºC; moderate, 34.0ºC to 34.9ºC; severe, < 34.0ºC) measured at the direct tympanic membrane, bladder, oesophagus, pulmonary artery, nasopharynx or rectum. We anticipated that this would be measured and reported in a variety of ways. We sought to collect temperatures for groups at one and two hours after induction of anaesthesia and at the end of the operation, or on arrival to postanaesthesia care. We also tried to collect data on risk of hypothermia at any time after induction of anaesthesiaMean core temperature. We made a post hoc decision to include this outcome after we reviewed the evidence, as none of the included studies reported risk of hypothermia (see Differences between protocol and review)Major cardiovascular complications (cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke and non‐fatal cardiac arrest)
primary outcome:
Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation
We included trials that reported the primary outcome of mortality (28‐day mortality, ICU mortality and in‐hospital mortality).
primary outcome:
Breastfeeding for procedural pain in infants beyond the neonatal period
Behavioural indicators such as:cry variables (duration of crying, expressed in total seconds of crying or proportion of duration of crying during painful procedure or following completion of painful procedure (recovery period));facial expressions (grimace); orbody posture and movements.Physiological responses such as heart rate, heart rate variability, respiratory rate, transcutaneous oxygen (TcPO2), transcutaneous carbon dioxide (TcPCO2), oxygen saturation (SpO2), or other measures such as skin conductance or biomedical markers (e.g. serum, salivary or urinary cortisol).Composite pain measures: unidimensional or multidimensional (including a combination of behavioural, physiological, and contextual indicators).
primary outcome:
Anaesthetic interventions for prevention of awareness during surgery
Awareness or wakefulness as defined using the awareness classification system in Table 1.
primary outcome:
Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS)
Total blood loss (blood loss during surgery measured as blood collected in the suction apparatus and by weight of the nasal swabs).
primary outcome:
Fentanyl for neuropathic pain in adults
Participant‐reported pain relief of 30% or greaterParticipant‐reported pain relief of 50% or greaterPGIC much or very much improvedPGIC very much improved
primary outcome:
Hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section
Inadequate pain control requiring conversion to general anaesthesia (dichotomous)Inadequate pain control requiring use of supplemental analgesics (dichotomous)
primary outcome:
Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm
Primary analgesia or anaesthesia failure. This was represented by the use of any additional anaesthetic or surgical intervention to ensure adequate surgical anaesthesia. This outcome can be measured or defined in various ways. It can be: a) incomplete overall sensory block or analgesia; or b) incomplete or inadequate sensory block or analgesia for the specific surgery undertaken at an appropriate (generally 30 minutes) time interval after completion of the blocking procedure.Failure is also indicated by one or more of the following: use of supplementary analgesia either to ensure a) complete overall analgesia or b) analgesia for the surgical site; change in anaesthesia method, such as recourse to general anaesthesia; and the curtailment or modification of the planned surgical procedure due to inadequate anaesthesia. We also reported incomplete motor block.
primary outcome:
Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding
Overall mortality. We used the longest follow‐up data from each trial, regardless of the period of follow‐up.
primary outcome:
Nitrous oxide‐based versus nitrous oxide‐free general anaesthesia and accidental awareness during general anaesthesia in surgical patients
Accidental awareness during general anaesthesia (AAGA): defined as when a patient becomes conscious during a procedure performed with general anaesthesia and subsequently has explicit recall of this event. The qualitative aspects of awareness may be reported on a scale such as the Michigan awareness classification instrument (Mashour 2010), and we included recall of any type of event (auditory or tactile with or without distress, i.e. class 1 and above on the Michigan awareness instrument). Study investigators may also classify any reports of awareness as definite, probable or possible. Precise definitions vary between studies (Mashour 2009; Sandin 2000) but definite events are often those confirmed by attending personnel; probable events are those that the investigators were convinced were real, but for which no confirmation could be obtained; and possible cases occur in patients who were unable to recall any event definitely that would have been indicative of true awareness. For studies which divide awareness in this way, we included probable and definite awareness events only. We classified reported events with a high probability of occurring before or after anaesthesia as no awareness.
primary outcome:
Nitrates for the prevention of cardiac morbidity and mortality in patients undergoing non‐cardiac surgery
All‐cause mortality up to 30 days post operation.
primary outcome:
Local anaesthetic sympathetic blockade for complex regional pain syndrome
The outcomes of interest were pain intensity levels, duration of pain relief. and adverse events. For this update, we excluded studies that had only immediate follow‐up data (≤ 48 h), because this information provides little clinically relevant information about the effectiveness of this treatment. We applied this new criterion to studies that had been included in previous updates of this review.
primary outcome:
Oxycodone for neuropathic pain in adults
Participant‐reported pain intensity reduction of 30% or greater.Participant‐reported pain intensity reduction of 50% or greater.PGIC much or very much improved.PGIC very much improved.
primary outcome:
Percutaneous techniques versus surgical techniques for tracheostomy
Mortality directly related to the procedureIntraoperative mortality (measured as the proportion of participants who died intraoperatively)Postoperative mortality (measured as the proportion of participants who died during the first 24 hours after the intervention)Serious, life‐threatening adverse eventsIntraoperative serious, life‐threatening adverse events (major vascular injury or excessive bleeding (determined by need for blood transfusion or an additional surgical procedure), tracheal or oesophageal injury (detected by intraoperative bronchoscopy), loss of the airway (loss of the tube or tracheostoma tube > 20 sec) or a misplaced airway (paratracheal insertion of the tube or the tracheostoma tube), a severe hypoxic episode, or cardiac arrest)Direct postoperative serious, life‐threatening adverse events (major vascular injury or excessive bleeding (determined by need for blood transfusion or an additional surgical procedure), a severe hypoxic episode, or saturation < 90%.
primary outcome:
High initial concentration versus low initial concentration sevoflurane for inhalational induction of anaesthesia
Induction time (time to loss of eyelash reflex (LOER), assessed in seconds (beginning from inhalation of gas until LOER); or time to drop a weighted object, assessed in seconds (beginning from inhalation of gas until weighted object, for example, a weighted syringe, dropped); or time to successfully insert laryngeal mask.
primary outcome:
Paracetamol for low back pain
Pain intensityDisability
primary outcome:
Nutritional support for critically ill children
30‐day mortality. If this was not available, then paediatric intensive care unit (PICU) mortality.
primary outcome:
Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia
the pre‐specified postoperative pain outcome (if given);a visual analogue scale (VAS), for example from 0 to 100 (or 0 to 10);McGill Pain Questionnaire (MPQ) (Melzack 1975) intensity rating, Present Pain Intensity;other MPQ ratings: i) Pain Rating Index (weighted or unweighted), ii) Number of Words Counted;Short Form‐36 (SF‐36) pain (Ware 2000);Nottingham Health Profile pain (Hunt 1983);other pain intensity scale.SF‐36 physical function (Ware 2000);Nottingham Health Profile: Physical mobility (Hunt 1983);Barthel Index (Mahoney 1965);Western Ontario and McMaster Osteoarthritis Index (WOMAC) functional status (Bellamy 1988).
primary outcome:
Hydromorphone for neuropathic pain in adults
Participant‐reported pain relief of 30% or greater.Participant‐reported pain relief of 50% or greater.PGIC much or very much improved.PGIC very much improved.
primary outcome:
Midazolam for sedation before procedures
Effective sedation corresponding to adequate sedation level, anxiolysis, ability to complete proposed procedure. This was evaluated by:1.1. Level of sedation on a sedation assessment scale;1.2. Numeric rating scale of anxiety or number of participants rated as anxious;1.3. Vital signs (heart rate, blood pressure, respiratory rate, and oxygen saturation);1.4. Tolerance of procedure or participant co‐operation (as defined/measured by the authors of the trial);1.5. Participant or proceduralist satisfaction (as defined/measured by the authors of the trial);1.6. Proportion of incomplete procedures or where there was difficulty performing the procedures.
primary outcome:
Lateral positioning for critically ill adult patients
In‐hospital mortality (mortality within the critical care area and mortality before the time of discharge from the hospital).Incidence of morbidity (with particular focus on pulmonary and cardiovascular morbidity).Clinical adverse events during or after repositioning (with particular focus on cardiopulmonary events), for example:hypoxaemia (including arterial oxygen saturation (SaO2) and/or partial pressure of arterial oxygen (PaO2) critical thresholds);cardiac arrhythmias;profound hypertension (including diastolic blood pressure (DBP) critical threshold);hypotension (including mean arterial blood pressure (MABP) and/or systolic blood pressure (SBP) critical thresholds); andother indicators of haemodynamic compromise such as alterations in oxygen delivery determinants (including cardiac output (CO) or cardiac index (CI), arterial oxygen content (CaO2) and/or oxygen delivery index (DO2I) critical thresholds) or global indicators of tissue oxygenation (including mixed venous oxygen concentration (SvO2) and oxygen consumption index (VO2I) critical thresholds).
primary outcome:
Topical NSAIDs for chronic musculoskeletal pain in adults
Participant‐reported reduction in pain of at least 50%.Participant‐reported global assessment of treatment.Pain on movement.Pain at rest or spontaneous pain.
primary outcome:
Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults
Surgical site infection and complications (wound healing and dehiscence)Major cardiovascular complications (cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke and non‐fatal cardiac arrest)All‐cause mortality
primary outcome:
Catheter impregnation, coating or bonding for reducing central venous catheter‐related infections in adults
Number of participants with clinically diagnosed sepsis. We used the diagnostic criteria developed from the 2001 Society of Critical Care Medicine/The European Society of Intensive Care Medicine/American College of Chest Physicians/American Thoracic Society/Surgical Infection Society (SCCM/ESICM/ACCP/ATS/SIS) International Sepsis Definitions Conference (Levy 2003), as detailed in Appendix 1. This set of diagnostic criteria contains an extensive list of clinical features and investigation findings, with no clear statement regarding the minimum number or thresholds required to satisfy a diagnosis of sepsis. Therefore, we accepted various definitions adopted by the authors of each study, as long as the items included in their definitions were those contained in this set of diagnostic criteria. We would, however, also accept definitions that were not consistent with this set of diagnostic criteria, provided the authors justified their definitions with validated sources. We would then analyse those studies that followed such diagnostic criteria and those that adopted other definitions as subgroups .Number of participants with laboratory‐proven catheter‐related bloodstream infection (CRBSI), defined as an isolate of the same organism from a semi‐quantitative or quantitative culture of a catheter segment and from separate percutaneous blood cultures, with no other identifiable source of infection (CDC 2011).All‐cause mortality.
primary outcome:
Spectral entropy monitoring for adults and children undergoing general anaesthesia
Time to awakening (defined as either time to extubation in intubated patients, or eye opening in response to verbal commands, or spontaneous movements in non‐intubated patients) after stopping the anaesthetic agent.Mortality with the use of the entropy monitor at 24 hours, 30 days, and one year.
primary outcome:
Paravertebral block versus thoracic epidural for patients undergoing thoracotomy
Mortality to 30 days.Major complications including any of: cardiovascular complications (systemic hypotension requiring inotropic support, significant arrhythmias requiring anti‐arrhythmic or cardioversion treatment, myocardial infarction, pulmonary oedema); pulmonary complications requiring treatment (postoperative ventilatory support, reintubation for respiratory failure, acute carbon dioxide retention (CO₂ > 45 mmHg), pneumonia, atelectasis); neurological complications (delirium); unexpected admission to intensive care; any complications that lead to further surgery.
primary outcome:
Lidocaine for reducing propofol‐induced pain on induction of anaesthesia in adults
The incidence of high‐intensity pain on propofol injection.'High‐intensity pain’ was defined as the combination of moderate and severe pain levels. For different scales in each included study, we defined ‘low‐ and high‐intensity pain’ according to the definition of the scoring system of each included study. ‘Low‐intensity pain’ included mild pain, pain mentioned only when questioned, without any behavioural signs. ‘High‐intensity pain’ included moderate pain, severe pain, pain mentioned when questioned and accompanied by behavioural signs, or pain reported spontaneously not as a result of questioning, pain associated with grimacing, withdrawal movement of forearm, tears. In case the definition of the pain score was not clear, we categorized one‐third of the lower range of pain scores as ‘low‐intensity pain’ and two‐thirds of the upper range of pain scores as ‘high‐intensity pain’.
primary outcome:
Vasopressors for hypotensive shock
We looked at total mortality (in the ICU, in hospital and at one year) as the main endpoint. If mortality was assessed at several time points in a study, we used data derived from the latest follow‐up time.
primary outcome:
Pharmacological and non‐pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults
Pain on rocuronium bromide injection measured by a pain score assessment.
primary outcome:
Intranasal or transdermal nicotine for the treatment of postoperative pain
Postoperative pain scores at rest, as reported by participant on a numerical rating scale or categorical rating scale at 60 minutes, 12 hours, and 24 hours.Postoperative hourly morphine equivalents. Morphine equivalents are a way of uniformly assessing the amount given in milligrams per kilogram per hour across various opioids.
primary outcome:
Epidural pain relief versus systemic opioid‐based pain relief for abdominal aortic surgery
Death from all causes within 30 days of surgery, or death from all causes during hospitalization.
primary outcome:
Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation
Reported event rate or prevalence of aspiration determined by:documented gastric aspiration determined by visual inspection of aspirated stomach contents on laryngoscopy;pepsin detection in tracheal aspirate using the Ufberg method (Ufberg 2004);post‐anaesthetic radiographic changes suggestive of aspiration pneumonitis;any combination of the above.
primary outcome:
Prone position for acute respiratory failure in adults
Short‐term mortality (10 to 30 days, or ICU mortality).Longer‐term mortality (> 30 days, or hospital mortality).
primary outcome:
Nitrous oxide‐based techniques versus nitrous oxide‐free techniques for general anaesthesia
Inhospital case fatality rate (number or proportion of deceased participants after a defined period following anaesthesia).
primary outcome:
Rocuronium versus succinylcholine for rapid sequence induction intubation
The primary outcome assessed was excellent intubation conditions created during RSI (or modified RSI) comparing rocuronium with succinylcholine.
primary outcome:
Non‐pharmacological interventions for sleep promotion in the intensive care unit
Changes in objective sleep variables (as measured by polysomnography, ActiGraph, or Bispectral Index), including Sleep Efficiency Index (SEI), rapid eye movement (REM) sleep time, REM sleep latency, and sleep fragmentation index.Length of ICU stay.Mortality.
primary outcome:
Ultrasound guidance for upper and lower limb blocks
Block success defined as predicted adequacy of block (using sensory and motor testing)Block success defined as participants given supplementation of block/conversion to general anaestheticBlock complications
primary outcome:
Regional analgesia for improvement of long‐term functional outcome after elective large joint replacement
Our primary outcome was the improvement in joint function 3, 6 or 12 months after joint replacement.There are outcome scores specific for each joint. We planned to use the appropriate score for each joint: The most commonly used scores are the Knee Society Score following total knee arthroplasty (Knee Society), the Harris Hip Score following total hip arthroplasty (Harris 1969), and the Constant Score following total shoulder arthroplasty (Constant 1987), but only one study used these indicators, and we could not obtain the information needed to score the included participants from the published data or the authors. Each joint has its specificities (surgical and anaesthetic techniques, outcomes), so we did not consider pooling data from knee, hip and shoulder operations. The outcome should have been the difference between the preoperative and the postoperative score, that is, the improvement in function.Only one study reported a global function score. Three studies, however, reported the knee range of motion, or maximal flexion, and that was also used as a surrogate outcome for knee function.The included studies reported a variety of outcomes at 3, 6 and 12 months after joint replacement (Table 3).Wu 2014 reported Knee Society Scores at three and six months. Kadic 2009 used the Knee Society Score at three months, but reported the results in two components rather than a total score, making pooling impossible. We were not able to obtain raw data from the authors.Only four studies (Kadic 2009; Singelyn 1998; Tammachote 2013; Zhang 2011) reported the knee range of motion at three months, but Kadic 2009 only gave the data as mean (range). Nader 2012 only reported the difference in knee flexion from baseline at 1, 6 and 12 months on a graph, but we were able to obtain data on knee range of motion (ROM) at 6 and 12 months from the authors.
primary outcome:
Alpha‐2 adrenergic agonists for the prevention of shivering following general anaesthesia
incidence of core/ transitional temperature less than 36 oC at any time from induction of anaesthesia until 12 hours after the end of the surgical procedure or arrival at PACU; orcore/ transitional temperature at 30, 60, 90, 120 minutes after induction, at the end of the surgical procedure, on arrival at PACU, or other times within 12 hours postoperatively.
primary outcome:
Early versus late removal of the laryngeal mask airway (LMA) for general anaesthesia
laryngospasm;coughing;desaturation; andairway obstruction.
primary outcome:
The use of propofol for procedural sedation in emergency departments
Adverse effects (as defined by the study authors).Participant satisfaction (as defined by the study authors).
primary outcome:
Lidocaine for preventing postoperative sore throat
Risk of sore throat 12 hours to 30 hours after the operation.
primary outcome:
Non‐pharmacological interventions for assisting the induction of anaesthesia in children
The number of children with distress or anxiety, or the extent of presence or absence of distress or anxiety (as defined and measured by the authors of the study) during induction of general anaesthesia;The number of children who co‐operate, or the extent of presence or absence of co‐operation (as defined and measured by the authors of the study) during induction of general anaesthesia.
primary outcome:
Peribulbar versus retrobulbar anaesthesia for cataract surgery
Pain: experienced during surgery and measured using a visual analogue scale (VAS) (1 to 10) or any other method as described in the primary report.Ocular akinesia: the degree to which the ocular muscles were paralysed and the eye immobilized, i.e. complete akinesia.Acceptability of block to patients: the number of participants who reported that the blocks were acceptable to them.
primary outcome:
The effects of high perioperative inspiratory oxygen fraction for adult surgical patients
All‐cause mortality: assessed according to the longest follow‐up period for each trial.Surgical site infection within 30 days of follow‐up after surgery: defined by investigators of involved trials or according to the criteria of the CDC (Appendix 1) as superficial or deep wound infection or intra‐abdominal organ or space infection (Mangram 1999).
primary outcome:
Exercise rehabilitation following intensive care unit discharge for recovery from critical illness
Functional exercise capacity (with physical objective assessment and/or subjective assessment). This was defined as an individual’s maximal ability to perform functional exercise beneficial for activities of daily living, including walking, stair climbing, sit‐to‐stand exercises and strength.Health‐related quality of life, as measured by reliable assessment scales (see Differences between protocol and review).
primary outcome:
Tapentadol for chronic musculoskeletal pain in adults
Primary efficacy outcome: pain control assessed by change in pain intensity scores and responder's rate (at least 50% pain relief).Primary safety outcome: withdrawal rate due to adverse effects.
primary outcome:
Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia
Risk of hypothermia at any point during surgery and temperature at the end of surgery or on admission to postanaesthesia care (mild, core temperature 35.0ºC to 35.9ºC; moderate, 34.0 ºC to 34.9 ºC; severe, < 34.0ºC) measured at the direct tympanic membrane, bladder, oesophagus, pulmonary artery, nasopharynx or rectum. As no data were found on rates of hypothermia, we made a post hoc decision to use data reporting mean core temperatures at various time points during and after surgery.Major cardiovascular complications (cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke and non‐fatal cardiac arrest).
primary outcome:
Adrenaline with lidocaine for digital nerve blocks
Duration of anaesthesia reported in minutes/hours.Adverse outcome such as ischaemia distal to the injection site reported as a dichotomous outcome.Cost analysis.
primary outcome:
Zonisamide for neuropathic pain in adults
Participant‐reported pain relief of 50% or greater.Participant‐reported pain relief of 30% or greater.PGIC very much improved.PGIC much or very much improved.
primary outcome:
Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization
The primary outcome measured was the total number of perioperative and postoperative complications/adverse events ((*) absolute numbers (n/N) and expressed as percentages (%)).
primary outcome:
Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization
The primary outcome measured was the total number of perioperative and postoperative complications/adverse events (*absolute numbers (n/N) and expressed as percentages (%) (*)).
primary outcome:
Nortriptyline for neuropathic pain in adults
Patient‐reported pain relief of 30% or greater.Patient‐reported pain relief of 50% or greater.PGIC much or very much improved.PGIC very much improved.
primary outcome:
Conservative versus interventional management for primary spontaneous pneumothorax in adults
Immediate success ‐ defined as clinical resolution with substantial radiological improvement of pneumothorax within 28 days without complicationsFailure of treatment ‐ defined as need for a secondary intervention within 28 daysMortality ‐ all causes within 28 daysDuration of hospitalization ‐ measured in nights in hospital from first presentation
primary outcome:
Intranasal fentanyl for the management of acute pain in children
Reduction in pain score or intensity assessed by validated age‐appropriate pain scores (e.g. 'Faces, Legs, Activity, Cry, Consolability' (FLACC); Wong Baker; numerical rating scale (NRS); visual analogue scale (VAS)).
primary outcome:
Desipramine for neuropathic pain in adults
Patient‐reported pain relief of 30% or greaterPatient‐reported pain relief of 50% or greaterPGIC much or very much improvedPGIC very much improved
primary outcome:
Effects of sevoflurane versus other general anaesthesia on emergence agitation in children
Emergence agitation (EA) was defined as the number of participants with postoperative behavioural disturbance, as measured by the authors of included studies.
primary outcome:
Botulinum toxin for myofascial pain syndromes in adults
Intensity, frequency and duration of pain, pain relief, and pressure pain tolerance recorded using validated visual analogue scales (VAS) or categorical scales
primary outcome:
Topical lidocaine for neuropathic pain in adults
Patient‐reported pain relief of 30% or greaterPatient‐reported pain relief of 50% or greaterPGIC much or very much improvedPGIC very much improved
primary outcome:
Air versus saline in the loss of resistance technique for identification of the epidural space
Inability to locate the epidural space, defined as inability to identify the epidural space and/or unintentional dural puncture by epidural needle.Accidental intravascular catheter placement* and/or accidental subarachnoid catheter placement*.Combined spinal epidural failure* (i.e. inability to reach subarachnoid space and/or no fluid return by spinal needle puncture and/or spinal analgesia failure).
primary outcome:
Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy
Longest follow‐up mortality.Outcome at three months (Glasgow Outcome Scale score).Adverse events such as electrolyte imbalance, haemodynamic disturbance, rebound oedema and kidney injury.
primary outcome:
Physician anaesthetists versus non‐physician providers of anaesthesia for surgical patients
Mortality within 30 days of anaestheticFailure to rescue between induction and full recovery ("defined as the rate of death after complications" (Silber 2000a))Anaesthesia‐related complications (including cardiac, pulmonary and central nervous system complications due to anaesthesia all within 30 days of anaesthetic)
primary outcome:
Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation
The primary outcome was the total duration of invasive mechanical ventilation (time in days from intubation to successful extubation, defined as no requirement for either reintubation or recommencement of mechanical ventilation in the case of tracheostomy for 48 hours, or as defined by study authors, or death).
primary outcome:
Levetiracetam for neuropathic pain in adults
Participant‐reported pain relief of 30% or greaterParticipant‐reported pain relief of 50% or greaterPGIC much or very much improvedPGIC very much improved
primary outcome:
Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease
Long‐term mortalityMortality prior to discharge
primary outcome:
Automated versus non‐automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children
The total duration of ventilator weaning, where weaning was defined as the time in hours from study randomization to successful extubation or discontinuation of invasive and non‐invasive mechanical ventilation (defined as no requirement for either reintubation or recommencement of mechanical ventilation (in the case of tracheostomy) for 24, 48, or 72 hours, or as defined by study authors), or death
primary outcome:
Pressure support versus T‐tube for weaning from mechanical ventilation in adults
Weaning success (defined as the absence of the requirement for ventilatory support within 48 hours after extubation (translaryngeal tube) or withdrawal (tracheostomy tube) of MV, or as defined by the authors)
primary outcome:
Imipramine for neuropathic pain in adults
Patient‐reported pain relief of 30% or greater.Patient‐reported pain relief of 50% or greater.PGIC much or very much improved.PGIC very much improved.
primary outcome:
Heparin versus normal saline for patency of arterial lines
Duration of arterial line utility (i.e. reliability of arterial pressure and waveform quality, the ease with which the flush solution can be infused and arterial blood withdrawn).
primary outcome:
Permissive hypoxaemia versus normoxaemia for mechanically ventilated critically ill patients
Mortality at longest follow‐up and overall 28‐day mortality.
primary outcome:
Neostigmine for reversal of neuromuscular block in paediatric patients
Mortality of children in the postoperative period.Risk of assisted ventilation (including mask ventilation, laryngeal mask airway and intubation) after extubation.
primary outcome:
High‐flow nasal cannula therapy for respiratory support in children
Hospital mortality.Intubation rate.Treatment failure (defined as the need for additional respiratory support).
primary outcome:
Automated weaning and spontaneous breathing trial systems versus non‐automated weaning strategies for discontinuation time in invasively ventilated postoperative adults
The primary outcome was time to mechanical ventilation discontinuation (from randomization to extubation) as defined by the study authors.
primary outcome:
Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery
Pulmonary complications, defined as:atelectasis (radiographic, tomographic, or bronchoscopic diagnosis: in patients whose clinical signs were acute respiratory symptoms such as dyspnoea, cough, wheeze);respiratory failure (radiographical diagnosis: in patients with signs of acute respiratory symptoms such as tracheobronchial purulent secretions, fever (greater than 38 ºC), or increased white blood cell count (greater than 10,000/mm3);tracheobronchial infection or pneumonia.Other types of complications in the postoperative period.Total mortality from respiratory causes.Evidence of harms from IS.All‐cause mortality.
primary outcome:
Intravenous versus inhalational anaesthesia for paediatric outpatient surgery
The risk of postoperative nausea and vomiting (PONV)The risk of admission or readmission to hospitalThe risk of postoperative behavioural disturbances (defined as disturbances during the recovery from general anaesthesia that consist of hallucinations, delusions and confusion manifested by moaning, restlessness, involuntary physical activity and thrashing about in the bed)
primary outcome:
Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery
The effectiveness of pain relief after major shoulder surgery using continuous ISBPB or parenteral opioid analgesia for the entire follow‐up period (minimum 12 hours).Complications related to ISBPB including those related to technique (failure, pneumothorax, nerve injury, Horner's syndrome, vascular injury, haematoma, bleeding, catheter dislocation, infection, facial nerve palsy) and those related to drugs (nausea, vomiting, pruritus, metallic taste, motor block, sedation, respiratory depression, central nervous system excitation).Complications related to parenteral analgesia (nausea, vomiting, pruritus, sedation, respiratory depression).
primary outcome:
Fibrinogen concentrate in bleeding patients
Overall mortality. We used the longest follow‐up data from each trial regardless of the period of follow‐up.*Overall 28‐day mortality. We included data provided as 30‐day mortality in the same analysis.*
primary outcome:
Opioids for neuropathic pain
In our updated review the primary outcomes we sought were the proportion of participants reporting at least 33% pain reduction from baseline or 50% or more pain reduction from baseline. The selection of these outcomes, as opposed to the primary outcomes in our original review (mean pain intensity difference or mean pain relief) was based on the observation that pain relief tends to be bimodal, rendering mean values less useful. A greater than or equal to 33% (or ≥ 30%) pain reduction from baseline was based upon analyses demonstrating that such a reduction was required for people with chronic pain to perceive a clinically meaningful change in pain intensity (Farrar 2001). More recent evidence suggests that at least 50% pain relief is clinically significant, because high levels of pain relief are strongly associated with improved fatigue, sleep, depression, work ability and quality of life (Moore 2010a). While such data are rarely reported in older studies, we anticipated that those studies found in our updated search would report them.Where studies did not report numbers of participants with at least 33% or 50% improvement, but reported numbers of participants reporting certain categories of global impression of change, e.g. "much improved", we translated these categories to equate to either at least 33% pain reduction from baseline or at least 50% pain reduction from baseline (Dworkin 2008).
primary outcome:
Protocolized versus non‐protocolized weaning for reducing the duration of invasive mechanical ventilation in critically ill paediatric patients
Duration of mechanical ventilation (MV), measured in hours.
primary outcome:
Neuraxial anaesthesia for lower‐limb revascularization
Mortality (participants died during their hospital stay or during their follow‐up time).Cerebral stroke (death of cerebral cells).Myocardial infarction (death of heart cells).Nerve dysfunction (loss of nerve function).Rate of lower‐limb amputation, both in the operating room and during the postoperative period.
primary outcome:
Pharmacotherapy for the prevention of chronic pain after surgery in adults
Proportion of participants reporting any pain at the anatomical site of the procedure or pain referred to the surgical site, or both (for example phantom limb pain, shoulder pain referred from the diaphragm etc.), three months or more after the procedure.
primary outcome:
Intravenous versus inhalation anaesthesia for one‐lung ventilation
Mortality rate (during the total observation period);Adverse postoperative outcomes, such as brain damage, heart failure, myocardial infarction and blood transfusion (analysed separately); andIntraoperative awareness (as subsequently reported by the participant).
primary outcome:
Single dose oral ibuprofen plus oxycodone for acute postoperative pain in adults
Participants achieving at least 50% pain relief over 4 to 6 hours.
primary outcome:
Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain
Participants achieving at least 50% of maximum pain relief over four to six hours.
primary outcome:
Metered dose inhalers versus nebulizers for aerosol bronchodilator delivery for adult patients receiving mechanical ventilation in critical care units
Reduction in airway resistance, measured as a reduction in interrupter resistance (Rint ) and additional effective resistance (ΔRrs)Patient outcome, mortality during critical care unit admissionPatient outcome, duration of mechanical ventilation
primary outcome:
Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus
Reporting the outcome measures listed below was not an eligibility criterion.Considering time points, where relevant, we planned to synthesise outcomes from infancy/childhood/adulthood.We did not restrict outcomes according to measurement methods or tools used, and planned wherever possible to synthesise different measures of the same outcome (or outcome domain).
primary outcome:
Alternative magnesium sulphate regimens for women with pre‐eclampsia and eclampsia
Measures of clinical outcome and use of health service resources for the mother and, for women randomised before delivery, the baby.
primary outcome:
Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy
All‐cause mortality, defined as either fetal or neonatal mortalityFetal mortality, defined as death before or during birthNeonatal mortality, defined as death after birth
primary outcome:
Planned hospital birth compared with planned home birth for pregnant women at low risk of complications
Maternal mortality                                  Perinatal mortality (non‐malformed)      Apgar < 7 at 5 minutesTransfer to neonatal intensive care unit (NICU)Caesarean section                          Baby not breastfed                       Maternal satisfaction
primary outcome:
Induction of labour at or near term for suspected fetal macrosomia
We identified four trials (Boulvain 2015; Gonen 1997; LIBBY 1998; Tey 1995), involving a total of 1190 women.
primary outcome:
Cervical pessary for preventing preterm birth in singleton pregnancies
Delivery before 34 weeks' gestation (including spontaneous and induced labour)
primary outcome:
Maternal postures for fetal malposition in labour for improving the health of mothers and their infants
The primary and secondary maternal and neonatal outcome measures were based on consensus between the review authors.
primary outcome:
Different corticosteroids and regimens for accelerating fetal lung maturation for babies at risk of preterm birth
These cover outcomes of maternal morbidity, perinatal morbidity and mortality, child morbidity and mortality, child as adult morbidity and mortality, and the use of health services by the mother and by the neonate or child.They are divided into primary outcomes, thought to be the most clinically relevant, and secondary outcomes of importance, including possible complications and also additional measures of effectiveness. Groups include: women, fetuses/neonates, children, children as adults and health services.
primary outcome:
Routine vaginal examinations compared to other methods for assessing progress of labour to improve outcomes for women and babies at term
Positive birth experienceAugmentation of labourSpontaneous vaginal birthChorioamnionitisNeonatal infection (as defined by study authors)Admission to neonatal intensive care unit (NICU)Maternal pain (as defined by study authors)
primary outcome:
Interventions for fear of childbirth including tocophobia
Fear of childbirth as measured by a validated tool such as the Wijma Delivery Expectancy Questionnaire version A (W‐DEQ A) (Wijma 1998), or a visual analogue scale (VAS) known as the Fear of Birth Scale (FOBS) (Rouhe 2011).
primary outcome:
Low‐dose oral misoprostol for induction of labour
(1) Vaginal birth within 24 hours;(2) caesarean section;(3) uterine hyperstimulation with foetal heart rate (FHR) changes.
primary outcome:
Methods for managing miscarriage: a network meta‐analysis
Complete miscarriage: this is defined as evidence of complete evacuation of uterine contents based on clinical findings or ultrasound examination after a specific time period as defined in the primary studies. Outcomes were pooled regardless of the timeframe for assessment.Composite outcome of death or serious complications (e.g. uterine perforation, need for further life‐saving procedures including hysterectomy, blood transfusion or intensive care unit admission).
primary outcome:
Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section
Nausea intraoperatively.Vomiting (and/or retching) intraoperatively.Nausea postoperatively.Vomiting (and/or retching) postoperatively.
primary outcome:
Umbilical vein injection for management of retained placenta
Manual removal of the placenta.Maternal mortality.Severe postpartum haemorrhage (PPH) (defined as clinically estimated blood loss of 1000 mL or greater).Blood transfusion.Addition of therapeutic uterotonics.Need for treatment with antibiotics (infection).Maternal postpartum anaemia (defined by the haemoglobin concentration according to local standards).
primary outcome:
Oral non‐steroidal anti‐inflammatory drugs (single dose) for perineal pain in the early postpartum period
Adequate pain relief as reported by the woman, or by determination of greater than 50% relief of pain (either as stated by the woman or as calculated using a formula)*Need for additional analgesia for relief of perineal painMaternal drug adverse effects, e.g. nausea, vomiting, sedation, constipation, diarrhoea, drowsiness, sleepiness, psychological impactNeonatal drug adverse effects, e.g. nausea, vomiting, sedation, constipation, diarrhoea, drowsiness, sleepiness, psychological impact
primary outcome:
Paracetamol/acetaminophen (single administration) for perineal pain in the early postpartum period
Adequate pain relief as reported by the woman (as determined by more than 50% relief of pain stated by the woman or calculated using a formula; see Data collection and analysis for details).Additional pain relief.Maternal drug adverse effects, composite of any of the following: nausea, vomiting, sedation, constipation, diarrhoea,  drowsiness, sleepiness, psychological impact.Neonatal drug adverse effects, composite of any of the following: vomiting, sedation, constipation, diarrhoea, sleepiness.
primary outcome:
Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth
Perinatal death (composite of fetal death (in utero death) and neonatal death).Neonatal death (before 28 completed days of life).Fetal death (in utero death).Respiratory distress syndrome (RDS).Moderate/severe RDS.Chronic lung disease (need for continuous supplemental oxygen at 28 days postnatal age or 36 weeks' postmenstrual age, whichever was later).Intraventricular haemorrhage (IVH).Mean birthweight (g).Maternal death (up to 90 days after giving birth).Chorioamnionitis (however defined by study authors).Endometritis (however defined by study authors and including infections).Death.Neurodevelopmental disability at follow‐up (visual impairment, hearing impairment, intellectual impairment defined as intelligence quotient less than ‐2 standard deviation below population mean, moderate/severe cerebral palsy (however defined by study authors), or developmental delay (defined as developmental quotient less than ‐2 standard deviation below population mean)).Death.Neurodevelopmental disability at follow‐up (visual impairment, hearing impairment, intellectual impairment defined as intelligence quotient less than ‐2 standard deviation below population mean, moderate/severe cerebral palsy (however defined by study authors), or developmental delay (defined as developmental quotient less than ‐2 standard deviation below population mean)).
primary outcome:
Multi‐professional simulation‐based team training in obstetric emergencies for improving patient outcomes and trainees' performance
Kirkpatrick's model of training evaluation was used to categorise the outcomes of interest. Level 3 (behavioural change) and Level 4 (patient outcome) were our main interest and formed the primary outcomes of the review. Level 2 (acquisition of knowledge and skills) and Level 1 (participant experience) were secondary outcomes.
primary outcome:
Uterotonic agents for first‐line treatment of postpartum haemorrhage: a network meta‐analysis
Additional blood loss of 500 mL or more after recruitment to the trial until cessation of active bleedingComposite outcome of maternal death or severe morbidity (e.g. hysterectomy, any organ dysfunction, transfer to higher level of care, coagulopathy, shock as defined by trialists)
primary outcome:
Intravenous versus intramuscular prophylactic oxytocin for reducing blood loss in the third stage of labour
Severe PPH (blood loss of 1000 mL or more)Serious maternal morbidity (organ failure, coma, intensive care unit (ICU) admission, hysterectomy, or as defined by the study authors)
primary outcome:
Maintenance agonist treatments for opiate‐dependent pregnant women
4. Health status
primary outcome:
Interventions for preventing mastitis after childbirth
Incidence of mastitis within six months postpartum, diagnosed by a combination of women's self‐reported symptoms and clinical examinationRecurrence of mastitis within 12 months postpartum
primary outcome:
Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies
Serious neonatal morbidity (as defined by trialists).Perinatal loss: all losses including miscarriages, stillbirth and neonatal deaths.Baby discharged home healthy (without obvious pathology, as defined by trialists).
primary outcome:
Home versus inpatient induction of labour for improving birth outcomes
Spontaneous vaginal birth (noting data for within 24 hours or within 48 to 72 hours if reported) (COS)Uterine hyperstimulation (with or without fetal heart (FHR) changes ‐ noting data for with or without FHR changes if reported) (COS)Caesarean birth (COS)Neonatal infection (COS) (up to 28 days after the birth)Admission to neonatal intensive care unit (NICU) (COS)Serious neonatal morbidity or mortality (e.g. seizures, birth asphyxia defined by trialists, birth trauma, neonatal encephalopathy, need for therapeutic hypothermia, disability in childhood) (COS) up to 28 days after the birthWomen's experiences/satisfaction with care (using only validated instruments) (COS) up to eight weeks after the birth
primary outcome:
Aspirin (single dose) for perineal pain in the early postpartum period
Adequate pain relief, as reported by the woman*Need for additional pain relief in the first 48 hours for perineal painMaternal adverse effects, composite of any of the following: nausea, vomiting, sedation, constipation, diarrhoea, drowsiness, sleepiness, gastric discomfort, psychological impactNeonatal adverse effects, composite of any of the following: vomiting, sedation, constipation, diarrhoea, drowsiness, sleepiness
primary outcome:
Induction of labour at or beyond 37 weeks' gestation
Perinatal death (defined as intrauterine death plus neonatal death in the first week of life)
primary outcome:
Techniques for preventing hypotension during spinal anaesthesia for caesarean section
The incidence of maternal hypotension requiring pharmacological intervention (after intrathecal injection and prior to delivery), where hypotension was a certain decrease in systolic or mean blood pressure, as defined and measured by the authors of included studies (Table 1).We excluded studies if hypotension was not an outcome measure or was not clearly defined prior to administering a rescue treatment.
primary outcome:
Mechanical and surgical interventions for treating primary postpartum haemorrhage
Mortality due to bleedingHysterectomy to control bleedingSerious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure)
primary outcome:
Skin preparation for preventing infection following caesarean section
Surgical site infection (as defined by trialists)Metritis or endometritis, or both