■鼻内(IN)药物在静脉内(IV)进入和肌内(IM)给药具有挑战性或不可行的情况下,提供了一种安全的非侵入性方式来快速输送药物。在院前环境中,这可能是在包括创伤管理在内的时间紧急情况下的重要替代方案,癫痫发作,和烦躁的病人。然而,缺乏证据来总结其在这种环境中的功效。本系统评价旨在评估当前支持使用IN药物的证据(咪达唑仑,氯胺酮,芬太尼,吗啡,胰高血糖素,和纳洛酮)仅在院前环境中。
■PubMed的系统文献检索(PROSPEROCRD42023440713),WebofScience,OVIDMedline,“科克伦受控试验中央登记册”,Cochrane审查和Embase从开始到2023年6月进行,以确定在院前环境中对患者施用IN药物的研究。所有随机对照试验,观察性队列研究,案例系列,并纳入病例报告。论文不是用英语写的,评论文章,摘要,和未发表的数据(包括给编辑的信件)被排除在外。纳入研究的方法学质量使用Cochrane偏倚风险工具进行解释,并使用建议评级评估进行评级,发展,和评估(等级)方法。没有收到资金。
■来自4818项研究,包括39个(咪达唑仑有7个,五份氯胺酮,12代表芬太尼,一个是二吗啡,胰高血糖素两个,纳洛酮十二个)。在所有研究中,共有24,097名患者接受了IN药物治疗。有五个中等质量,四个低质量和30个非常低质量的研究。在整个研究中,IN芬太尼和氯胺酮的潜在疗效得到一致证明,咪达唑仑的证据不那么明确。吗啡,胰高血糖素,还有纳洛酮.这篇综述受到研究质量的严重限制,大多数研究表明,“高度关注”偏见。
■院前药物管理具有广泛的潜力,特别是用于镇痛。可能有某些人群,例如儿科,这将受益最大,尽管结论受到目前可用证据质量的限制。我们鼓励在这方面进行更多的研究,特别是稳健的前瞻性双盲随机对照试验。
UNASSIGNED: Intranasal (IN) medications offer a safe non-invasive way to rapidly deliver drugs in situations where intravenous (IV) access and intramuscular (IM) administration is challenging or not feasible. In the
prehospital setting, this can be an essential alternative in time critical situations including trauma management, seizures, and agitated patients. However, there is a paucity of evidence summarizing its efficacy in this environment. This systematic
review aims to assess the current evidence supporting the use of IN medicine (midazolam, ketamine, fentanyl, morphine, glucagon, and naloxone) in the
prehospital setting alone.
UNASSIGNED: A systematic literature search (PROSPERO CRD42023440713) of PubMed, Web of Science, OVID Medline, \"Cochrane Central Register of Controlled Trials,\" Cochrane reviews and Embase was performed from inception to June 2023 to identify studies where IN medications were administered to patients in the prehospital setting. All randomized controlled trials, observational cohort studies, case series, and case reports were included. Papers not written in English,
review articles, abstracts, and non-published data (including letters to the editor) were excluded. The methodological quality of the included studies was interpreted using the Cochrane risk of bias tool and rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. No funding was received.
UNASSIGNED: From 4818 studies, 39 were included (seven for midazolam, five for ketamine, twelve for fentanyl, one for diamorphine, two for glucagon, and twelve for naloxone). A total of 24,097 patients were treated with IN medications across all the studies. There were five moderate quality, four low quality, and thirty very low quality studies. The potential efficacy of IN fentanyl and ketamine was demonstrated consistently throughout the studies with less clear evidence for midazolam, morphine, glucagon, and naloxone. This
review was severely limited by the study quality, with most studies demonstrating \"high concerns\" for bias.
UNASSIGNED: Prehospital IN medication administration has wide-ranging potential, particularly for administering analgesia. There are likely to be certain populations, for example, pediatrics, that will benefit the most, although conclusions are limited by the quality of evidence currently available. We encourage additional research in this area, particularly with robust prospective double-blind RCTs.