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Signal of harm in morphine use in adults with acute pulmonary oedema: A rapid systematic review

SAMJ: South African Medical Journal, 2023-08, Vol.113 (8), p.39-43 [Peer Reviewed Journal]

COPYRIGHT 2023 Health & Medical Publishing Group ;This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. ;ISSN: 0256-9574 ;ISSN: 2078-5135 ;EISSN: 2078-5135 ;DOI: 10.7196/SAMJ.2023.v113i8.348 ;PMID: 37882120

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  • Title:
    Signal of harm in morphine use in adults with acute pulmonary oedema: A rapid systematic review
  • Author: Hendrikse, C ; Ngah, V ; Kallon, I I ; Thom, G ; Leong, T D ; Cohen, K ; McCaul, M
  • Subjects: Adult ; Animals ; cardiopulmonary disease ; Care and treatment ; Complications and side effects ; Dropsy ; Drug therapy ; Edema ; Essential Medicines ; Health Care Sciences & Services ; Health Policy & Services ; Hominidae ; Humans ; Medical care, Cost of ; Medical Ethics ; Medicine, General & Internal ; Medicine, Legal ; Medicine, Research & Experimental ; Morphine ; Morphine Derivatives ; Mortality ; Pharmaceutical research ; Pulmonary edema ; Pulmonary Edema - drug therapy ; Randomized Controlled Trials as Topic ; Respiratory agents ; Review ; South Africa ; Systematic Reviews as Topic
  • Is Part Of: SAMJ: South African Medical Journal, 2023-08, Vol.113 (8), p.39-43
  • Description: Heart failure affects nearly 65 million people globally, resulting in recurrent hospital admissions and substantial healthcare expenditure. The use of morphine in the management of acute pulmonary oedema remains controversial, with conflicting guidance and significant variation in practice. Synthesised evidence is needed to inform standard treatment guidelines and clinical practice. To determine whether morphine should be used in the treatment of acute pulmonary oedema (APE) in adults. A rapid review of systematic reviews of randomised controlled trials or observational studies, and then randomised controlled trials, was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on 12 February 2022. We used a prespecified protocol following Cochrane rapid review methods and aligned to the National Standard Treatment Guidelines and Essential Medicines List methodology. We first considered relevant high-quality systematic reviews of randomised controlled trials or observational studies, then (if required) randomised controlled trials to inform time-sensitive or urgent evidence requests, clinical practice, policy, or standard treatment guidelines. We identified four systematic reviews of observational studies. The two most relevant, up-to-date, and highest-quality reviews were used to inform evidence for critical outcomes. Morphine may increase in-hospital mortality (odds ratio (OR) 1.78; 95% confidence interval (CI) 1.01 - 3.13; low certainty of evidence; six observational studies, n=151 735 participants), resulting in 15 more per 1 000 hospital deaths, ranging from 0 to 40 more hospital deaths. Morphine may result in a large increase in invasive mechanical ventilation (OR 2.72; 95% CI 1.09 - 6.80; low certainty of evidence; four observational studies, n=167 847 participants), resulting in 45 more per 1 000 ventilations, ranging from 2 more to 136 more. Adverse events and hospital length of stay were not measured across reviews or trials. Based on the most recent, relevant and best-available quality evidence, morphine use in adults with APE may increase in-hospital and all-cause mortality and may result in a large increase in the need for invasive mechanical ventilation compared to not using morphine. Recommending against the use of morphine in pulmonary oedema may improve patient outcomes. Disinvesting in morphine for this indication may result in cost savings, noting the possible accrued benefits of fewer patients requiring invasive ventilation and management of morphine-related side-effects.
  • Publisher: South Africa: Health & Medical Publishing Group
  • Language: English;Portuguese
  • Identifier: ISSN: 0256-9574
    ISSN: 2078-5135
    EISSN: 2078-5135
    DOI: 10.7196/SAMJ.2023.v113i8.348
    PMID: 37882120
  • Source: SciELO
    African Journals Online (Open Access)
    GFMER Free Medical Journals
    MEDLINE
    Alma/SFX Local Collection
    DOAJ Directory of Open Access Journals
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