Summary of findings 1. Slow passive expiration versus control for acute bronchiolitis.
| Slow passive expiration versus control for acute bronchiolitis | ||||||
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Patient or population: paediatric participants between 0 and 24 months old with acute bronchiolitis Settings: hospital Intervention: slow passive expiration Comparison: control | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Physiotherapy | |||||
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Time to recovery/time to clinical stability Recovery defined as attaining an ABSS clinical score below 2. (follow‐up until hospital discharge) |
Mean time to recovery 4.4 days (3.7 to 5.1 days) | Mean time to recovery 2.6 days (2.1 to 3.1 days) | NA | 71 (1 trial) | ⊕⊕⊝⊝ Lowa | Participants with mild to moderate bronchiolitis (Conesa‐Segura 2018) |
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Change in the severity status of bronchiolitis Assessed using a variety of scales (follow‐up ranging from 1 hour to hospital discharge) |
Mean Wang score of 7.5 (Gomes 2012)b | The mean severity score in the intervention group was 0.7 lower (1.2 lower to 0.3 lower).b | SMD −0.43 (−0.73 to −0.13) | 434 (7 trials) | ⊕⊕⊝⊝
Lowc |
Participants with mild to moderate bronchiolitis (Conesa‐Segura 2018; Gomes 2012; Gomes 2016; Lopez Galbany 2004; Postiaux 2011; Ramos‐Pinto 2021; Van Ginderdeuren 2017) |
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Adverse events (follow‐up until hospital discharge) |
4 studies reported no adverse events. 1 study reported more episodes of nasal bleeding (28 vs 1) and vomiting (11 vs 7) in the control aspiration group than the clearance physiotherapy group. 1 study reported no direct complications (respiratory deterioration with oxygen desaturation, bradycardia, vomiting) due to treatment in any participant. There were 4.3% cases (2 controls and 2 experimental) of complications due to bronchiolitis severity. |
565 (6 trials) | ⊕⊝⊝⊝
Very lowd |
Participants with severe bronchiolitis (Sanchez Bayle 2012) Participants with mild to moderate bronchiolitis (Conesa‐Segura 2018; Gomes 2016; Postiaux 2011; Ramos‐Pinto 2021; Sanchez Bayle 2012; Van Ginderdeuren 2017) |
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| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ABSS: Acute Bronchitis Severity Score; CI: confidence interval; NA: not applicable: SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded for unclear risk of bias and serious imprecision of estimates due to small sample size. bAssumed risk was taken from the baseline mean severity of the control group in Gomes 2012, which was measured with the Wang severity score and presented low risk of bias in the meta‐analysis. SMD was back‐transformed into a mean difference multiplying the standard deviation of the Gomes 2012 control group (mean change from baseline to end of study) by the pooled SMD. cDowngraded for unclear risk of bias and imprecision of estimates. Inconsistency of results (I2 = 55%) did not result in reduced certainty of the evidence because the sensitivity analysis reached similar results with no inconsistency. dDowngraded for unclear risk of bias, serious imprecision of estimates, and serious indirectness of assessments because in 4 of the 6 trials it was unclear what adverse effects were assessed, and 1 of the trials only assessed participants in the intervention group.