DISCUSSION
Summary of main results
The currently available evidence from 4 RCTs ( 39) (40) (41) (42) indicates that GL with paraffin oil is an effective treatment for acute AlP poisoning, decreasing the mortality rate compared with the standard therapy (RR = 0.62 ; 95%CI = 0.48 to 0.81 ; participants = 226; I2=10%;low-quality evidence). In the subgroup analysis, this effect was only maintained among those participants with the longest latency (≥ 2 hs) of AlP exposure (RR = 0.50 ; 95% CI= 0.34 to 0.74; participants=124; studies = 2; very low-quality evidence ). However, these results are probably influenced by the small number of clinical trials, possibly unsuitable for performing a subgroup analysis or for a meta-regression.
Likewise, the evidence indicates that this intervention reduces the need for intubation and mechanical ventilation (RR = 0.62 ; 95%CI = 0.40 to 0.79 ; participants= 226; I2 = 0%;low-quality evidence) . These benefits have not been reflected in thelength of hospital stay (MD= 10.73; 95%CI = -2.28 to 23.74; I2 = 65%). The level of heterogeneity could be explained by the results of one of the trials, in which the duration of hospital stay was significantly longer in the paraffin oil group because of a higher percentage of survivors (39). The exclusion of this trial gives an MD of 5.64 (95% CI -2.20 to 13.47) decreasing the level of heterogeneity (I2 = 33%).
Finally, the need for vasopressors was lower among the participants who received GL with paraffin oil ( RR=0.76 ; 95%CI= 0.61 to 0.94; studies= 3;I2= 1%; low-quality evidence )
We calculated an NNT from the mortality rate of GL withparaffin oil (38.9% in the paraffin oil versus 66.4% in the control group), estimating an NNT of 4 (3.6).
Regarding GL with coconut oil , the available evidence from 4 RCTs (37)(38)(42)(43), indicates a slight reduction in mortality in patients with acute AlP poisoning (RR= 0.82 ; 95%CI = 0.69 to 0.98 ; participants= 112; I 2= 0%; very low-quality evidence ). Again, through the subgroup analysis, this effect was only observed among those with more than 2 hs latency from AlP exposure (RR= 0.78 ; 95%CI = 0.64 to 0.96; studies = 3; very low-quality evidence ). This effect was not reflected in the other outcomes considered.