Prostacyclin for pulmonary arterial hypertension

Abstract

Trusted evidence. Informed decisions. Better health.

Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews

“…Most reviews focused on adult populations generally or specifically, for example, pregnant women and adults with amyotrophic lateral sclerosis (ALS). Two reviews, however, are specifically paediatric [26,27]; eight all ages [15,16,25,28,[29][30][31][32]; two focused on older adults and paediatrics [33,34] and one where age was not reported [24].…”

“…Recommendations informed by the level of evidence are also provided in Table 4 for each of the outcomes. Overall, there is strong evidence to recommend SCI for hydration in older adults [ 16 , 23 , 34 , 39 , 46 – 48 ], weak evidence for pediatrics [ 27 , 28 , 33 ], and inclusive evidence for palliative patients [ 16 , 39 , 42 , 49 ].…”

“…A review of SC hydration in neonatal palliative population found no articles studying this population, although a survey of French nurses working in these two settings found 86% were interested in establishing protocols for the SC route for analgesia, anxiolysis or terminal sedation [67]. Although not actually studied in these settings, use of SC hydration in resource-limited settings may be recommended, particularly in the pediatric setting if intraosseous or nasogastric access is unavailable due to the ease of use and training requirements, compared to IV access [28,50].…”

“…It is also possible that the quality of evidence may be higher; however, the lack of reported methodological details led to downgrading of the overall confidence in results. Investigation of alternate routes was beyond the scope of this study; however, nasogastric and intraosseous rehydration has been shown to be effective in the pediatric population [28].…”

“…Both hydration and medication reviews included the use of hyaluronidase, an enzyme that facilitates subcutaneous absorption [15,23,27,28,33,34,39,40,42,[48][49][50]. Spandorfer and colleagues [50] report that hyaluronidase is safe, effective and well tolerated in subcutaneous 1 Findings further described in S6 Table; + number of times outcomes reported within primary studies; +, moderate-high quality study; 2 Most were mild to moderate in severity (except 1 severe pain) and local site reactions;…”