Systematic ReviewResearchMedication Safety

Small neonatal trials suggest hydrocortisone may reduce mortality in refractory hypotension

The Canadian journal of hospital pharmacy (PubMed)Sep 9, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review and meta-analysis of five placebo-controlled randomized trials found lower mortality with intravenous hydrocortisone among neonates with hypotension, but the evidence base included only 239 patients.

What NurseJet pulled from the source

The fixed-effect meta-analysis found an odds ratio for all-cause mortality of 0.48 with intravenous hydrocortisone versus placebo (95% CI 0.24 to 0.96), with low statistical heterogeneity. The authors state that larger trials are needed before the finding is considered confirmed.

Why this matters for nurses

Hydrocortisone may be considered when neonatal hypotension persists despite volume and vasoactive support, but this mortality signal comes from a small evidence base and should not be presented as definitive.

Bedside takeaway

Treat the mortality signal as promising but preliminary, and follow local NICU monitoring and escalation protocols.

Key takeaways

Five randomized, placebo-controlled trials with a total of 239 neonates were included.
The pooled mortality estimate favored hydrocortisone, but the confidence interval approached no difference.
The abstract addresses mortality only and does not provide pooled adverse-event or longer-term neurodevelopmental outcomes.

Practice implications

When hydrocortisone is ordered for refractory neonatal hypotension, continue close hemodynamic and medication monitoring and follow the NICU's dosing, glucose, electrolyte, and escalation protocols.

Limitations & cautions

Abstract-only summary. Only five trials and 239 neonates were pooled; the abstract does not report gestational-age subgroups, dosing differences, adverse events, or neurodevelopmental outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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The Canadian journal of hospital pharmacy (PubMed)

The Canadian journal of hospital pharmacy (PubMed). Effect of IV Hydrocortisone on Mortality among Neonates with Hypotension: A Systematic Review and Meta-analysis of Randomized, Placebo-Controlled Trials.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42699817/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Anesthesiology (PubMed)Sep 9, 2026Systematic Review

A systematic review and meta-analysis of randomized trials found that perioperative selective COX-2 inhibitors likely produced a clinically meaningful reduction in acute pain-related interference with daily function.

Med-SurgAI summaryReview source

Systematic ReviewResearchMedication SafetyAI summary · original source linked below

Across 38 randomized trials with 5,424 participants, selective COX-2 inhibitors reduced acute pain interference by 1.1 points on a 0-to-10 Brief Pain Inventory scale, meeting the review's 1-point threshold for minimal clinical importance. Evidence certainty for this outcome was moderate.

Key takeaways

The acute pain-interference estimate was based on seven trials and favored selective COX-2 inhibitors (mean difference -1.1, 95% CI -1.4 to -0.8).
Chronic pain incidence was lower in five trials, but certainty was low; chronic pain intensity was not significantly different in the single trial reporting it.
Quality of recovery improved slightly with low-certainty evidence, and the review found no differences in the other reported adverse events.

Why this matters on shift

Pain scores alone can miss how postoperative pain limits movement and daily activity. This review focused on functional interference and suggests a measurable benefit from selective COX-2 inhibitors while preserving uncertainty around longer-term outcomes and uncommon harms.

Bedside takeaway

Pair pain scores with functional assessment and monitor response within the ordered multimodal analgesia plan.

Nursing implications

Assess both pain intensity and pain-related function after surgery, and monitor medication response and contraindications according to the ordered multimodal analgesia plan and local protocol.

Limitations & cautions

Abstract-only summary. Chronic pain, quality-of-recovery, and adverse-event findings were supported by low- or very-low-certainty evidence, and the abstract does not describe results by specific drug, dose, or operation.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Anesthesiology (PubMed). Effectiveness of Selective Cyclooxygenase-2 Inhibitors for Postoperative Pain Management Using Multidimensional Pain Assessment: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Harvard review of psychiatry (PubMed)Sep 9, 2026Systematic Review

A systematic review and meta-analysis of seven randomized trials found that MDMA-assisted therapy may improve PTSD symptoms, dissociation, depression, and functional impairment compared with psychotherapy plus placebo or low-dose MDMA.

Psych Med-SurgAI summaryReview source

Systematic ReviewResearchMedication SafetyPatient EducationAI summary · original source linked below

The review included seven published and unpublished randomized trials identified through June 2025. Sleep quality did not improve, and the authors highlighted small samples, difficult blinding, nonstandardized psychotherapy, and common sponsorship across all trials.

Key takeaways

The pooled evidence favored MDMA-assisted therapy for core PTSD symptoms and several associated outcomes.
No benefit was found for sleep quality.
All trials shared a common sponsor, and psychedelic effects make participant and clinician blinding difficult.

Why this matters on shift

The findings help clinicians understand an emerging PTSD treatment evidence base while underscoring why symptom improvement in tightly controlled trials should not be equated with established routine practice.

Bedside takeaway

Frame MDMA-assisted therapy as emerging evidence with important blinding, sponsorship, and implementation limits.

Nursing implications

Use the findings for informed discussion and monitoring awareness, not independent treatment advice; follow current law, approved indications, specialist oversight, and facility policy.

Limitations & cautions

Abstract-only summary. The review included seven trials, some with small samples, and was limited by blinding challenges, nonstandardized psychotherapies, and a shared sponsor; the abstract does not report pooled effect sizes or adverse-event estimates.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Harvard review of psychiatry (PubMed). MDMA-Assisted Therapy May Decrease PTSD Symptoms, Dissociation, Depression, and Functional Disability: A Systematic Review and Meta-Analysis.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

World journal of critical care medicine (PubMed)Sep 9, 2026Research Article

A pre-post study of non-shockable in-hospital cardiac arrests found that allowing nurses to administer the first adrenaline dose under protocol shortened treatment time, without improving return of spontaneous circulation or survival.

ICU TelemetryAI summaryReview source

Research ArticleResearchWorkflowQuality ImprovementAI summary · original source linked below

Across 450 arrests, adrenaline within two minutes increased from 46.0% before the protocol to 74.3% after it, and median time to the first dose fell from four minutes to two. Return of spontaneous circulation rates were similar, and timely administration was not independently associated with return of spontaneous circulation.

Key takeaways

The comparison included 162 pre-intervention and 288 post-intervention cardiac-arrest events.
Time to return of spontaneous circulation was shorter after implementation, but overall return-of-spontaneous-circulation rates did not differ significantly.
Timely adrenaline was associated with faster return of spontaneous circulation in combined data but did not improve survival.

Why this matters on shift

The study suggests that a formally authorized nurse-led resuscitation workflow can reduce a process delay, while showing that faster medication delivery alone did not translate into better survival in this observational comparison.

Bedside takeaway

Know the local first-dose authority and rehearse rapid team activation and reversible-cause assessment.

Nursing implications

Know who is authorized to give first-dose adrenaline during a code, rehearse the local non-shockable-arrest workflow, and prioritize rapid team activation and reversible-cause assessment within facility protocol.

Limitations & cautions

Abstract-only summary. This was a nonrandomized pre-post study spanning different time periods; other changes in staffing or resuscitation practice could have influenced results, and survival did not improve.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

World journal of critical care medicine (PubMed). Impact of nurse empowerment for early adrenaline administration for in-hospital cardiac arrest resuscitation: A pre-post intervention study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Perioperative COX-2 inhibitors reduced acute pain interference with daily function

MDMA-assisted therapy may improve several PTSD outcomes, but trial limitations remain

A nurse-led protocol shortened time to adrenaline during non-shockable in-hospital arrests