Summary of findings 3. Magnesium sulfate compared to standard care (ipratropium bromide) for acute exacerbations of chronic obstructive pulmonary disease.
| Magnesium sulfate compared to (standard care) ipratropium bromide for acute exacerbations of chronic obstructive pulmonary disease | ||||||
| Patient or population: acute exacerbations of chronic obstructive pulmonary disease Setting: emergency department Intervention: magnesium sulfate Comparison: ipratropium bromide | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with ipratropium bromide | Risk with magnesium sulfate | |||||
| Proportion of people with hospital admissions (from the emergency room) | 323 per 1000 | 435 per 1000 (271 to 616) | OR 1.62 (0.78 to 3.37) | 124 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | |
| Proportion of people requiring endotracheal intubation | 113 per 1000 | 177 per 1000 (72 to 375) | OR 1.69 (0.61 to 4.71) | 124 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | ICU admission or non‐invasive ventilation not reported |
| Proportion of people with serious adverse events | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Length of hospital stay | The mean length of hospital stay was 6.6 days | MD 1.1 higher (0.22 lower to 2.42 higher) | ‐ | 124 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | |
| Change in oxygen saturation (SaO2) | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Change in dyspnoea score | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Lung function: FEV1 at 60 min | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| *The risk in the intervention group (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). CI: confidence interval; FEV1: forced expiratory volume in 1 second; ICU: intensive care unit ; RCT: randomised controlled trial; SaO2: arterial oxygen saturation; OR: odds ratio; MD: 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 two levels for very serious imprecision (few events and CI includes both appreciable benefit and harm) bDowngraded one level for study limitations (risk of detection and other bias)