Evidence map›Paper›PMID 41102836›Full record

ArticleJournal of intensive care2025

Association between early administration of mucoactive agents and in-hospital mortality in patients with pneumonia requiring mechanical ventilation: a nationwide cohort study.

Akira Sasaki, Mikio Nakajima, Tomohiro Shinozaki, Yusuke Sasabuchi, Hiroyuki Ohbe, Richard H Kaszynski, Yuya Kimura, Kojiro Morita, Tadahiro Goto, Yuki Aiyama and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of intensive care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Akira SasakiDepartment of Emergency and Critical Care Medicine, University of Miyazaki Hospital, Miyazaki, Japan.
Mikio NakajimaEmergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan. mickeyjmogulscob@gmail.com.
Tomohiro ShinozakiInterfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan.
Yusuke SasabuchiDepartment of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hiroyuki OhbeDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Richard H KaszynskiEmergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan.
Yuya KimuraDepartment of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kojiro MoritaDepartment of Nursing Administration and Advanced Clinical Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Tadahiro GotoDepartment of Health Data Science, Graduate School of Data Science, Yokohama City University, Kanagawa, Japan.
Yuki AiyamaDepartment of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Shimane, Japan.
Izumi NakayamaDepartment of Public Health, Yokohama City University School of Medicine, Yokohama, Japan.
Hiroki MatsuiDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Kiyohide FushimiDepartment of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan.
Hidenobu OchiaiDepartment of Emergency and Critical Care Medicine, University of Miyazaki Hospital, Miyazaki, Japan.
Hideo YasunagaDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Funding

National Science Foundation 23AA2003 and 24AA2006
6 · The paper itself

Abstract

backgroundIn patients with pneumonia requiring mechanical ventilation, increased airway secretions are associated with prolonged mechanical ventilation, but the effect of mucoactive agents remains unclear. The present study aimed to investigate the association between early administration of mucoactive agents and in-hospital mortality in patients with pneumonia requiring mechanical ventilation.

methodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database. Adult patients were eligible if they had a primary diagnosis of pneumonia and required invasive mechanical ventilation within 2 days of admission, with ventilation continued for ≥ 2 days between April 2012 and March 2023. Patients were divided into those who received at least one mucoactive agent within 2 days after the initiation of mechanical ventilation (mucoactive agent group) and those who did not (control group). Mucoactive agents included ambroxol (oral), bromhexine (oral, intravenous and nebulized), fudosteine (oral), carbocisteine (oral) and N-acetylcysteine (nebulized). We performed a propensity score overlap weighting analysis to compare in-hospital mortality. The number of ventilator-free days at 28 days was assessed as a secondary outcome. We also performed sensitivity analyses using inverse probability of treatment weighting, generalized estimating equations, and doubly robust methods.

resultsEligible patients (n = 10,942) were categorized into the mucoactive agent group (n = 2246) or control group (n = 8696). The most commonly prescribed mucoactive agent was carbocisteine (oral). After overlap weighting, in-hospital mortality was significantly lower in the mucoactive agent group than in the control group (25.2% vs. 27.5%; risk difference, - 2.3%; 95% confidence interval, - 4.4% to - 0.3%; p = 0.028). Ventilator-free days at 28 days did not significantly differ between the mucoactive agent group and the control group. Sensitivity analyses yielded similar results.

conclusionsIn patients with ventilated pneumonia, early administration of mucoactive agents was associated with lower in-hospital mortality.

Indexed as

Acute respiratory failureDoubly robustInverse probability of treatment weightingMortalityPropensity score overlap weightingSputum

Identifiers

PMID41102836
PMCPMC12532859

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.