RESUMO
BACKGROUND AND OBJECTIVES: Inhaled mucoactive agents are used to enhance airway clearance, however efficacy and safety are unclear in adults with acute respiratory conditions. METHODS: We systematically reviewed randomized controlled trials assessing respiratory function; safety; length of stay (LOS); mucus; radiology; and oxygenation. RESULTS: No adverse events were reported for dornase alfa (nâ¯=â¯63), N-acetylcysteine (NAC, nâ¯=â¯50), ambroxol (nâ¯=â¯140), hypertonic saline (nâ¯=â¯33), heparin (nâ¯=â¯384), mannitol (nâ¯=â¯20) or isotonic saline. During invasive ventilation, NAC, dornase alfa and saline had no effect on mucus. Postoperatively, mucus characteristics improved with NAC (nâ¯=â¯10). Ambroxol lowered LOS (mean difference 4 days) and halved complications following lung carcinoma resection (nâ¯=â¯140). Heparin improved ventilator-free days (nâ¯=â¯130, mean difference 3.9-4.6) and intensive care LOS (nâ¯=â¯223, 3.2 days), but not ventilator-acquired pneumonia. CONCLUSION: Dornase alfa, hypertonic saline and NAC were ineffective for atelectasis/mucus plugging while intubated. More data are required to support using NAC, ambroxol and heparin during acute illness.