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Broad synthesis / Living FRISBEE

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Is dexamethasone as effective as other corticosteroids for acute asthma exacerbation in children?

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Journal Medwave
Year 2017
Links Pubmed DOI

This article includes 6 Systematic reviews Systematic reviews (6 references) 13 Primary studies Primary studies (13 references)

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Dexamethasone has been proposed as an alternative in the treatment of acute asthma exacerbation in children. It allows shortening the duration of treatment, reducing costs and adverse effects. However, it is not clear whether its efficacy is similar to the traditional steroid regimen. To answer this question, we searched in Epistemonikos database, which is maintained by screening multiple information sources. We identified six systematic reviews including 10 randomized trials. We extracted data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded dexamethasone has probably fewer adverse effects than others corticosteroids, and might be equally effective in reducing hospitalizations and revisits.

Broad synthesis / Living FRISBEE

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What is the role of corticosteroids in the management of sepsis?

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Authors Jerez J , Castro R
Journal Medwave
Year 2016
Links Pubmed DOI

This article includes 16 Systematic reviews Systematic reviews (16 references) 53 Primary studies Primary studies (53 references)

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During an episode of sepsis, the systemic inflammatory response phenomenon triggers a deficit in the action and/or secretion of cortisol. It has been suggested that the use of corticosteroids may have a role in the management of sepsis, but there is no consensus. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 16 systematic reviews including 66 randomized controlled trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded the use of corticosteroids during a sepsis episode probably favors reversal of shock, briefly shortens the stay in intensive care unit and might reduce mortality, with few clinically relevant adverse effects.

Broad synthesis / Overview of systematic reviews

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Asthma and other recurrent wheezing disorders in children (acute).

Authors Okpapi A , Friend AJ , Turner SW
Journal Clinical evidence
Year 2012
Links Pubmed PubMed Central

This article includes 17 Primary studies Primary studies (17 references) 9 Systematic reviews Systematic reviews (9 references)

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INTRODUCTION: Acute childhood asthma is a common clinical emergency presenting across a range of ages and with a range of severities. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute asthma in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 35 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta2 agonists (high-dose nebulised, metered-dose inhaler plus spacer device versus nebuliser, intravenous), corticosteroids (systemic, high-dose inhaled), ipratropium bromide (single- or multiple-dose inhaled), magnesium sulphate, oxygen, and theophylline or aminophylline.

Broad synthesis

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Clinical review: a systematic review of corticosteroid use in infections.

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Authors Aberdein J , Singer M
Journal Critical care (London, England)
Year 2006
Links Pubmed DOI PubMed Central

This article includes 35 Primary studies Primary studies (35 references) 23 Systematic reviews Systematic reviews (23 references)

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Traditional teaching suggests that corticosteroids should be avoided during acute infectious episodes for fear of compromising the immune response. However, the outcome benefit shown through steroid administration in early septic shock implies this paranoia may be misplaced. We therefore performed a systematic review of the literature to identify the current strength of evidence for the use of corticosteroids in specified infections, and to make appropriate graded recommendations.