Introduction
Methods
Search strategy and eligibility criteria
Data extraction
Data synthesis and statistical analysis
Conclusions of RCTs
Results
Search results
At topic level | All 67 eligible topics | The 33 topics included in the sROR analysis | ||
---|---|---|---|---|
N =67 | N =33 | |||
Type of interventions | ||||
Drug intervention | 45 | 67.2% | 24 | 72.7% |
Devices | 12 | 17.9% | 5 | 15.2% |
Procedure | 10 | 14.9% | 4 | 12.1% |
Type of comparator | ||||
Active | 34 | 50.7% | 13 | 39.4% |
Placebo or no intervention | 31 | 46.3% | 18 | 54.5% |
Active, placebo or no intervention | 2 | 3% | 2 | 6.1% |
At RCT level | All 67 eligible topics | The 33 topics included in the sROR analysis | ||
---|---|---|---|---|
N =568 | N =363 | |||
Number of RCTs by sponsors | ||||
Industry | 88 | 15.5% | 61 | 16.8% |
Industry and non-profit organization | 73 | 12.9% | 52 | 14.3% |
Non-profit organization | 167a | 29.4% | 100b | 27.5% |
Supplied by industry | 20 | 3.5% | 13 | 3.6% |
NR | 144 | 25.4% | 104 | 28.7% |
NA | 76 | 13.4% | 33 | 9.1% |
Population included in RCTs | ||||
Adults | 464 | 81.7% | 286 | 78.8% |
Children | 16 | 2.8% | 9 | 2.5% |
Neonates | 29 | 5.1% | 21 | 5.8% |
Preterm | 17 | 3% | 17 | 4.7% |
NR | 42 | 7.4% | 30 | 8.3% |
Number of subjects included | ||||
Median (interquartile range) | 63 (40–133) | 71 (41–172) | ||
Total included | 92,034 | 71,283 | ||
Industry | 29,029 | 23,047 | ||
Industry and non-profit organization | 15,038 | 14,068 | ||
Non-profit organization | 26,783 | 18,497 | ||
Supplied by industry | 3393 | 2821 | ||
NR | 11,555 | 9125 | ||
NA | 6236 | 3725 |
Topics that did not have both trials with and without industry funding
Author | Year | Indication | Outcome | Funding type | Total trials included in meta-analysis | Trials with no reported funding | Trials with access barrier | Total sample size |
---|---|---|---|---|---|---|---|---|
Monro-Somerville | 2017 | Effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure | Hospital mortality | Industry | 5 | 0 | 0 | 1932 |
Stephens | 2018 | Early sedation depth in mechanically ventilated patients | Mortality | Industry and non-profit | 2 | 0 | 0 | 97 |
Shah | 2017 | Inhaled versus systemic corticosteroids for preventing bronchopulmonary dysplasia (BPD) in ventilated very low birth weight preterm neonates | BPD at 36 weeks | Supplied by industry | 3 | 0 | 0 | 429 |
Afshari | 2017 | Aerosolized prostacyclins for acute respiratory distress syndrome | Overall mortality | Non-profit | 2 | 0 | 0 | 81 |
Alarcon | 2017 | Elevation of the head in people with severe traumatic brain injury | Mortality at the end of study follow-up | Non-profit | 3 | 0 | 0 | 20 |
Avni | 2015 | Vasopressors for the treatment of septic shock | 28-day mortality | Non-profit | 11 | 2 | 6 | 1718 |
Borthwick | 2017 | High-volume hemofiltration for sepsis | Mortality | Non-profit | 2 | 0 | 0 | 156 |
Bradt | 2014 | Music interventions for mechanically ventilated patients | State anxiety | Non-profit | 5 | 2 | 0 | 288 |
Chacko | 2015 | Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury or acute respiratory distress syndrome | Mortality in hospital | Non-profit | 3 | 1 | 0 | 1089 |
Dervan | 2017 | Methadone to facilitate opioid weaning in pediatric critical care patients | Proportion developing withdrawal | Non-profit | 2 | 1 | 0 | 115 |
Hu | 2015 | Non-pharmacological interventions for sleep promotion | Total sleep time | Non-profit | 2 | 1 | 0 | 116 |
Huang | 2017 | Dexmedetomidine for one-lung ventilation in adults undergoing thoracic surgery | Intraoperative oxygenation index | Non-profit | 7 | 0 | 4 | 269 |
Korang | 2016 | Noninvasive positive pressure ventilation for acute asthma in children | Serious adverse events | Non-profit | 2 | 0 | 0 | 40 |
Morag | 2016 | Cycled light for preterm and low birth weight infants | Daily weight gain during neonatal care | Non-profit | 2 | 0 | 0 | 128 |
Pandor | 2015 | Pre-hospital noninvasive ventilation for acute respiratory failure | Mortality | Non-profit | 10 | 2 | 0 | 800 |
Rose | 2017 | Cough augmentation techniques for extubation or weaning | Extubation success | Non-profit | 2 | 1 | 0 | 95 |
Stuani | 2017 | Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure | Overall mortality | Non-profit | 5 | 2 | 0 | 1532 |
Wu | 2015 | Albuterol in the treatment of acute respiratory distress syndrome | Mortality | Non-profit | 3 | 0 | 0 | 646 |
Yang | 2017 | Early application of low-dose glucocorticoid improves acute respiratory distress syndrome | Mortality | Non-profit | 8 | 4 | 1 | 1218 |
Faria | 2015 | Noninvasive positive pressure ventilation for acute respiratory failure following upper abdominal surgery | Rate of tracheal intubation | NR | 2 | 2 | 0 | 269 |
Peng | 2017 | Delirium risk of dexmedetomidine and midazolam | Incidence of delirium | NR | 6a | 1 | 5 | 356 |
Suresh | 2001 | Superoxide dismutase for preventing chronic lung disease in mechanically ventilated preterm infants | Death before discharge | NR | 2 | 2 | 0 | 78 |
Wang | 2015 | Mannitol for acute severe traumatic brain injury | Mortality | NR | 2 | 2 | 0 | 53 |
Liu | 2016 | Thymosin alpha1 for sepsis | 28-day mortality | NA | 10a | 0 | 10 | 530 |
Zheng | 2018 | Xuebijing combined with ulinastatin for patients with sepsis | Mortality | NA | 11a | 0 | 11 | 741 |
Topics where the industry sponsor did not manufacture any of the compared interventions
Topics using a continuous outcome
Trials included in the ROR analyses
Author | Year | Indication | SMI | Control | Outcome | Trials with industry funding | Trials without industry funding | ROR p value | ROR | OR with industry funding | OR without industry funding |
---|---|---|---|---|---|---|---|---|---|---|---|
Aitken | 2015 | Mechanical ventilated | Protocol-directed sedation | Non-protocol-directed sedation | Hospital mortality | 1 | 1 | 0.21 | 1.56 (0.78; 3.15) | 1.21 (0.72; 2.04) | 0.78 (0.49; 1.24) |
Andriolo | 2017 | Sepsis | Procalcitonin-guided algorithm | No intervention | Mortality at longest FU | 3 | 1 | 0.69 | 1.21 (0.47; 3.09) | 1.03 (0.65; 1.65) | 0.86 (0.38; 1.94) |
Barrington | 2017 | Respiratory failure neonates | Nitric oxide | Placebo or no intervention | Death before hospital discharge | 3 | 6 | 0.96 | 1.02 (0.44; 2.38) | 0.97 (0.49; 1.94) | 0.95 (0.58; 1.55) |
Barrington | 2017 | Respiratory failure preterm | Nitric oxide | Placebo or no intervention | Death before hospital discharge | 9 | 4 | 0.50 | 1.2 (0.71; 2.04) | 1.05 (0.82; 1.36) | 0.88 (0.55; 1.4) |
Bednarczyk | 2017 | Fluid resuscitation | Dynamic assessment | No intervention | Mortality | 5 | 7 | 0.66 | 1.24 (0.47; 3.26) | 0.66 (0.28; 1.58) | 0.53 (0.35; 0.82) |
Beitland | 2015 | Adult ICU patients | Low molecular heparin | Unfractionated heparin | Any deep vein thrombosis | 2 | 1 | 0.81 | 0.9 (0.37; 2.17) | 0.76 (0.33; 1.77) | 0.85 (0.67; 1.07) |
Bellu | 2008 | Mechanically ventilated infants | Opioids | Placebo or no intervention | Neonatal mortality | 1 | 3 | 0.21 | 0.13 (0.01; 3.03) | 0.16 (0.01; 3.51) | 1.19 (0.81; 1.73) |
Busani | 2016 | Septic shock | Polyclonal intravenous immunoglobulin | Fluids or no intervention | Mortality | 6 | 2 | 0.29 | 3.8 (0.32; 45.2) | 0.91 (0.65; 1.27) | 0.24 (0.02; 2.77) |
Fujii | 2018 | Sepsis and septic shock | Polymyxin B-immobilized hemoperfusion | No intervention | 28-day mortality | 4 | 1 | 0.56 | 1.93 (0.21; 17.34) | 1.07 (0.68; 1.7) | 0.56 (0.06; 4.76) |
Gebistorf | 2016 | ARDS child and adult | Nitric oxide | Placebo or no intervention | Overall mortality | 5 | 5 | 1.00 | 1 (0.6; 1.67) | 1.06 (0.77; 1.45) | 1.06 (0.71; 1.58) |
Gillies | 2017 | Mechanically ventilated adults | Heated humidifiers | Heat and moisture exchangers | Artificial airway occlusion | 5 | 1 | 0.47 | 0.28 (0.01; 7.79) | 2.04 (0.48; 8.72) | 7.15 (0.37; 139.77) |
Guay | 2015 | Intraoperative acute lung injury in adults | Low tidal volume ventilation | High tidal volume ventilation | Mortality within 30 days after the surgery | 1 | 7 | 0.62 | 2.82 (0.05; 159.58) | 1.9 (0.04; 100.63) | 0.68 (0.32; 1.42) |
Kuriyama | 2015 | Mechanically ventilated adults | Closed tracheal suctioning systems | Open tracheal suctioning systems | Incidence of ventilator-associated pneumonia | 2 | 3 | 0.29 | 2.69 (0.43; 16.72) | 0.64 (0.34; 1.19) | 0.24 (0.04; 1.31) |
Liberati | 2009 | Adult ICU patients | Antibiotics | No prophylaxis | Mortality | 9 | 2 | 0.51 | 0.73 (0.29; 1.83) | 0.83 (0.69; 1) | 1.13 (0.46; 2.78) |
Liu | 2017 | Sepsis | Ulinastatin combined with thymosin alpha2 | Placebo or no intervention | 28-day mortality | 1 | 1 | 0.61 | 0.69 (0.17; 2.85) | 0.31 (0.09; 1.02) | 0.45 (0.21; 0.95) |
Lu | 2017 | Sepsis | Omega-3 | Placebo | Mortality | 6 | 3 | 0.72 | 1.25 (0.39; 3.99) | 0.87 (0.52; 1.48) | 0.7 (0.25; 1.98) |
Moeller | 2016 | Resuscitation | Gelatin-containing plasma expanders | Crystalloids or albumin | Mortality | 4 | 5 | 0.86 | 1.06 (0.56; 1.98) | 1.4 (0.83; 2.37) | 1.32 (0.94; 1.87) |
Nagendran | 2017 | ARDS | Statins | Placebo | 28-day mortality | 1 | 4 | 0.91 | 1.04 (0.58; 1.84) | 1.11 (0.79; 1.56) | 1.07 (0.67; 1.71) |
Osadnik | 2017 | Acute hypercapnic respiratory failure COPD adults | Noninvasive ventilation | No intervention | Endotracheal intubation | 1 | 9 | 0.16 | 0.17 (0.02; 1.96) | 0.05 (0; 0.54) | 0.29 (0.19; 0.43) |
Porhomayon | 2015 | ICU survivors | Light sedation | Heavy or standard sedation | Delirium | 2 | 5 | 0.75 | 1.26 (0.32; 4.99) | 1.02 (0.33; 3.18) | 0.81 (0.37; 1.77) |
Putzu | 2017 | ARD and sepsis in adults | Continuous veno-venous hemofiltration | No intervention | Mortality at longest follow-up | 2 | 2 | 0.95 | 0.87 (0.02; 42.85) | 0.27 (0.01; 11.97) | 0.31 (0.13; 0.76) |
Serpa | 2017 | Resuscitation in adults | Balanced saline | Isotonic saline | In-hospital mortality | 2 | 2 | 0.88 | 0.84 (0.08; 8.52) | 0.87 (0.65; 1.17) | 1.03 (0.1; 10.26) |
Shah | 2017 | Chronic lung disorders in infants | Corticosteroids | Placebo or no intervention | Chronic lung disease at 36 weeks post-menstrual age (among survivors) | 2 | 2 | 0.39 | 0.74 (0.38; 1.46) | 0.62 (0.46; 0.85) | 0.83 (0.46; 1.53) |
Siempos | 2015 | Mechanical ventilated | Early trachesotomy | Late tracheostomy | Mortality | 1 | 6 | 0.01 | 0.35 (0.15; 0.81) | 0.29 (0.14; 0.61) | 0.82 (0.58; 1.16) |
Sjovall | 2017 | Sepsis | Combination of antibiotics | One antibiotic | All-cause mortality | 7 | 1 | 0.92 | 1.02 (0.66; 1.58) | 1.18 (0.92; 1.52) | 1.16 (0.81; 1.66) |
Sole-Lleonart | 2017 | Mechanical ventilated | Nebulized antibiotics | Intravenous antibiotics | Nephrotoxicity | 1 | 1 | 0.07 | 0.05 (0; 1.21) | 0.06 (0; 1.24) | 1.18 (0.47; 2.97) |
Sud | 2016 | ARDS | High frequency oscillatory ventilation | Conventional or pressure controlled ventilation | Hospital or 30-day mortality | 4 | 3 | 0.21 | 2.48 (0.61; 10.19) | 1.03 (0.55; 1.94) | 0.41 (0.12; 1.46) |
Umemura | 2016 | Sepsis | Anticoagulants | Placebo or no intervention | Mortality | 9 | 7 | 0.87 | 1.03 (0.75; 1.41) | 0.96 (0.87; 1.07) | 0.94 (0.7; 1.26) |
Volbeda | 2015 | Sepsis | Corticosteroids | Placebo or no intervention | Mortality | 8 | 10 | 0.04 | 1.49 (1.02; 2.17) | 1.12 (0.86; 1.46) | 0.75 (0.57; 0.99) |
Wang | 2017 | Septic shock | Levosimendan | Dobutamine, placebo or no intervention | Mortality | 1 | 4 | 0.04 | 2.54 (1.06; 6.07) | 1.23 (0.86; 1.77) | 0.49 (0.22; 1.07) |
Zhang | 2015 | Sepsis | Antipyretic therapy | Placebo or no intervention | Mortality | 2 | 2 | 0.75 | 1.45 (0.15; 14.47) | 0.96 (0.11; 8.64) | 0.66 (0.34; 1.3) |
Zhang | 2017 | ARDS | N-Acetylcysteine | Placebo | Short-term mortality | 3 | 1 | 0.10 | 4.82 (0.76; 30.69) | 0.8 (0.38; 1.71) | 0.17 (0.03; 0.9) |
Primary analysis
Topics | N trials with industry funding | N trials without industry funding | sROR random effects | I2 (%; 95% CI) | τ2 | sROR fixed effect | |
---|---|---|---|---|---|---|---|
Primary analysis | 33 | 113 | 113 | 1.10 (0.96; 1.26) | 1% (0%; 40%) | 0.001 | 1.10 (0.96; 1.26) |
Sensitivity analyses | |||||||
Mortality outcomes only | 26 | 100 | 90 | 1.14 (0.98; 1.31) | 0% (0%; 38%) | 0 | 1.14 (0.98; 1.31) |
Supplied by industry merged with industry-funded trials | 32 | 118 | 100 | 1.12 (0.9; 1.4) | 36% (1%; 58%) | 0.109 | 1.17 (1.01; 1.36) |
Without 0 events in both arms | 32 | 106 | 101 | 1.10 (0.95; 1.27) | 2% (0%; 41%) | 0.0035 | 1.10 (0.96; 1.26) |
Without trials supplied by industry and without trials with SMI in both arms | 28 | 102 | 85 | 1.22 (1.02; 1.45) | 3% (0%; 44%) | 0.0065 | 1.22 (1.03; 1.44) |