***TASK***
the task is to simplify the input abstract of a biomedical literature

***INPUT***
the input is the abstract of a biomedical literature

***OUTPUT***
the output is the simplified abstract for the input abstract of a biomedical literature

***DOCUMENTATION***

***EXAMPLES***

Input: We included two RCTs with 81 participants. One RCT involved 14 critically ill children with ARDS (very low quality of evidence), and one RCT involved 67 critically ill adults (very low quality evidence). Only one RCT (paediatric trial) provided data on mortality and found no difference between intervention and control. However, this trial was eligible for meta-analysis due to a cross-over design. We assessed the benefits and harms of aerosolized prostacyclin. One RCT found no difference in improvement of partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) ratio (mean difference (MD) -25.35, 95% confidence interval (CI) -60.48 to 9.78; P = 0.16; 67 participants, very low quality evidence). There were no adverse events such as bleeding or organ dysfunction in any of the included trials. Due to the limited number of RCTs, we were unable to perform the prespecified subgroup and sensitivity analyses or trial sequential analysis. We are unable to tell from our results whether the intervention has an important effect on mortality because the results were too imprecise to rule out a small or no effect. Therefore, no current evidence supports or refutes the routine use of aerosolized prostacyclin for people with ARDS. There is an urgent need for more RCTs.
Output:

This review was updated in 2017. We included two randomized controlled trials (RCT; clinical studies where people are randomly put into one of two or more treatment groups), one involving 14 critically ill children with ARDS and one involving 67 critically ill adults with ARDS. The trials did not measure severity of illness, resolution of organ dysfunction, length of stay in intensive care unit or hospital, and quality of life. The study authors did not report side effects such as bleeding, organ dysfunction, airway reactivity or side effects unrelated to the intervention. None of the included trials reported receiving money from drug companies. Only the RCT involving children provided data on deaths, with no clear difference with and without prostacyclin. The RCT in adults reported a trend towards improved blood oxygen levels, for participants who were treated with alprostadil (prostaglandin E1). Therefore, we could not identify a clear advantage of the use of aerosolized prostacyclin in critically ill children or adults with low blood oxygen levels. The quality of the evidence was very low because of the limited number of participants and poor trial design. The RCT involving children used a cross-over design where one group received aerosolized prostacyclin first and the other group received saline (salt solution). They then changed over to the alternate treatment. There was insufficient information on the effect on death in both trials. We conclude that there is a need for a large-scale clinical trial with low risk of misleading information to investigate the advantages and harms of prostacyclin for critically ill people.