?. ?. ?. 一位 1 歲的寶寶由父母親帶來我小兒科求診 , 此次因下呼吸道感染由主治醫師收住院治療 , 過去該兒童曾在中部的醫學中心因肺炎住過院 , 父母親對於此次住院時開立的蒸氣吸入治療 (0.9% Sodium Chloride) 與醫學中心 (3% Sodium Chloride) 的製劑濃度不同 , 故想知道這兩種霧化吸入溶液治療效果的差別。. 情境題目. Foreground questions (Treatment).
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一位1歲的寶寶由父母親帶來我小兒科求診,此次因下呼吸道感染由主治醫師收住院治療,過去該兒童曾在中部的醫學中心因肺炎住過院,父母親對於此次住院時開立的蒸氣吸入治療 (0.9% Sodium Chloride) 與醫學中心 (3% Sodium Chloride) 的製劑濃度不同,故想知道這兩種霧化吸入溶液治療效果的差別。情境題目
(兒童下呼吸道感染霧化吸入治療中, 關於縮短住院天數, 3%食鹽水是不是比0.9%食鹽水好 ?)
PubMed SearchACQUIRING ~ Databases
搜尋策略 : Advance search
OR pneumonia AND inhalation)in Title, Abstract or
Keywords 6315 篇
fibrosis)in Title, Abstract or Keywords 252篇
#1 and #2
ACP Journal Club
12 + 1 link
Excluded articles from title and abstract
Excluded articles from full text
Excluded articles from study quality
Review study: 1
RCT study: 4
Cochrane Database of Systematic Reviews 2008, Issue 4
Level of evidence : 1a
Critical appraisal topic
Systemic Review ~ Screening Questions
Validity, Importance, Practice.
Q1: Didthe review ask aclearly-focused question ?
P: Children with viral bronchiolitis.
I: Inhalation 3% sodium chloride.
C: Inhalation 0.9% sodium chloride.
O: Reduce the length of hospital stay and clinical severity score.
Q2: Did the review include the right type of study ?
Q3: Did the reviewers try to identify all relevant studies?
Yes, 261 citations 7 potenitally relevant 4 met all the criteria.
Q4: Did the reviewers assess the quality of the included studies ?
Yes, 2 assessors, Jadad scoring system.
Q5: If the results of the studies have been combined, was it reasonable to do so?
The 3% saline group also had a significantly lower post-inhalation clinical score than the 0.9% saline group in the first three days of treatment. The effect of nebulized hypertonic saline in improving clinical score was greater among outpatients than inpatients.Systemic Review ~ Detailed Questions
Q6: How are the results presented and what is the main result ?
Nebulized hypertonic saline(3%) appears more effective than nebulized normal saline in reducing symptoms and shortening hospital stay in children with viral bronchiolitis.
J Pediatr 2007;151:266-70
Q7: How precise are these results ?
Nebulized 3% saline had a significantly shorter mean length of hospital stay compared with nebulized 0.9% saline mean difference -0.94 days, 95% CI -1.48 ~ -0.40, P = 0.0006.
Q8: Can the results be applied to the local population ?
Q9: Were all important outcomes considered ?
Q10: Should policy or practice change as a result of the evidence contained in this review ?
假如你(妳)的寶寶得到病毒性細支氣管炎,蒸氣治療使用3% sodium chloride,大約每治療14~20個人中就可以看到 縮短住院天數 這個差異。
Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Chest 2006 Jan;129 (78 references)
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