Is Chinese Medicine Injection Applicable for Treating Acute Lung Injury and Acute Respiratory Distress Syndrome? A Systematic Review and Meta-analysis of Randomized Controlled Trials
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To assess the efficacy and safety of Chinese medicine injection (CMI) for treating acute lung injury/acute respiratory distress syndrome (ALI/ARDS).
Randomized controlled trials (RCTs) were identified by searching 3 English databases and 4 Chinese databases from their inceptions until February 2019. The Cochrane Handbook was used to evaluate risk of bias in the included studies. Data analysis was conducted using RevMan 5.3.3 software.
A total of 19 eligible RCTs involving 1,334 participants was included in this systematic review and meta-analysis. The main meta-analysis showed that CMI combined with conventional therapy (CT) was more effective than CT alone in reducing the acute physiology and chronic health evaluation (APACHE) H score [mean difference (MD): −1.74 points, 95% confidence interval (CI): −2.77 to −0.71, I2=0] and increasing the total effective rate [relative risk (RR): 1.35, 95% CI: 1.17 to 1.56, I2=37%]. Compared with CT, CMI combined with CT showed improvements in the arterial partial pressure of oxygen (PaO2, MD: 9.25 mm Hg, 95% CI: 0.87 to 17.63, I2=98%) and oxygenation index [arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2), MD: 50.75 mm Hg, 95% CI: 35.18 to 66.31, I2=94%]. CMI plus CT was superior to CT in reducing the systemic inflammatory response syndrome (SIRS) score (MD: −0.84 points, 95% CI: −1.26 to −0.42, I2=65%), length of hospital stay (MD: −4.22 days, 95% CI: −6.49 to −1.95, I2=92%), and duration of mechanical ventilation (MD: −2.94 days, 95% CI: −4.68 to −1.21, I2=89%). Only 1 study reported adverse events.
CMI as an adjuvant therapy showed great potential benefits for the treatment of ALI/ARDS. However, we could not make a definite conclusion due to low quality of included studies and uncertain security. Future studies should focus on improving research design, especially in blindness and placebo. The reporting of adverse events was also needed.
KeywordsChinese medicine injection acute lung injury acute respiratory distress syndrome systematic review
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The authors thank Bo Li and evidence based clinical club for their help with methodological guidance.
Lin L initiated and supervised the study. Chen YB and Liu Q conceived the project, analyzed the data and drafted the manuscript. Xie H and Yin SM searched the electronic databases and screened and extracted the studies. Wu L and Yu XH evaluated the risk of bias, and interpreted the evidence from a clinical perspective. Fan L participated in the revision of the manuscript. All authors read and approved the final manuscript.
Conflict of Interest
The authors declare no conflicts of interest, and are responsible for the content and writing of the paper.
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