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

Background. Heart failure affects nearly 65 million people globally, resulting in recurrent hospital admissions and substantial healthcare expenditure. The use of morphine the management acute pulmonary oedema remains controversial, with conflicting guidance significant variation practice. Synthesised evidence is needed to inform standard treatment guidelines clinical Objective. To determine whether should be used (APE) adults. Methods. A rapid review systematic reviews randomised controlled trials or observational studies, then trials, was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) one trial registry on 12 February 2022. We a prespecified protocol following methods aligned National Standard Treatment Guidelines Essential Medicines List methodology. first considered relevant high-quality (if required) time-sensitive urgent requests, practice, policy, guidelines. Results. identified four studies. two most relevant, up-to-date, highest-quality were for critical outcomes. Morphine may increase in-hospital mortality (odds ratio (OR) 1.78; 95% confidence interval (CI) 1.01 - 3.13; low certainty evidence; six n=151 735 participants), 15 more per 1 000 deaths, ranging from 0 40 deaths. result large invasive mechanical ventilation (OR 2.72; CI 1.09 6.80; n=167 847 45 ventilations, 2 136 more. Adverse events length stay not measured across trials. Conclusion. Based recent, best-available quality evidence, adults APE all-cause need compared using morphine. Recommending against improve patient Disinvesting this indication cost savings, noting possible accrued benefits fewer patients requiring morphine-related side-effects.