2.
| Morphine compared with midazolam in people with breathlessness in advanced disease or terminal illness | ||||||
|
Patient or population: adults with refractory breathlessness Setting: outpatient setting Intervention: morphine Comparison: midazolam | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Midazolam | Morphine | |||||
| Breathlessness: post‐treatment score1 | The mean dyspnoea score in the midazolam group was 4 | The mean post‐treatment score was 2 points higher in the opioids group (ranging from 1.07 to 2.93) | — | 63 (1 RCTs) | ⊕⊝⊝⊝ very low2,3,4 | A lower score indicates an improvement in breathlessness |
| *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% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
1The study authors assessed breathlessness according to the numeric rating scale (NRS) for dyspnoea at 5 days. 2Limitations in the design and implementation of available studies suggest a high risk of bias. 3There was only one study. 4There was evidence of significant heterogeneity.
Abbreviations: RCT: randomised controlled trial; CI: confidence interval; RR: risk ratio.