Neuromuscular blocking agents in patients with acute respiratory distress syndrome: a summary of the current evidence from three randomized controlled trials

Ary Serpa Neto, Victor Galvão Moura Pereira, Daniel Crepaldi Espósito, Maria Cecília Toledo Damasceno, Marcus J Schultz, Ary Serpa Neto, Victor Galvão Moura Pereira, Daniel Crepaldi Espósito, Maria Cecília Toledo Damasceno, Marcus J Schultz

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a potentially fatal disease with high mortality. Our aim was to summarize the current evidence for use of neuromuscular blocking agents (NMBA) in the early phase of ARDS.

Methods: Systematic review and meta-analysis of publications between 1966 and 2012. The Medline and CENTRAL databases were searched for studies on NMBA in patients with ARDS. The meta-analysis was limited to: 1) randomized controlled trials; 02) adult human patients with ARDS or acute lung injury; and 03) use of any NMBA in one arm of the study compared with another arm without NMBA. The outcomes assessed were: overall mortality, ventilator-free days, time of mechanical ventilation, adverse events, changes in gas exchange, in ventilator settings, and in respiratory mechanics.

Results: Three randomized controlled trials covering 431 participants were included. Patients treated with NMBA showed less mortality (Risk ratio, 0.71 [95 % CI, 0.55 - 0.90]; number needed to treat, 1 - 7), more ventilator free days at day 28 (p = 0.020), higher PaO2 to FiO2 ratios (p = 0.004), and less barotraumas (p = 0.030). The incidence of critical illness neuromyopathy was similar (p = 0.540).

Conclusions: The use of NMBA in the early phase of ARDS improves outcome.

Figures

Figure 1
Figure 1
Literature search strategy.
Figure 2
Figure 2
Effect of neuromuscular blockade in patients with ARDS at the end of the follow-up period for each study.
Figure 3
Figure 3
Changes in PaO2/ FiO2( circles ), plateau pressure ( triangles ) and PEEP (squares ) between patients under NMBA ( continuous line and closed symbols ) and controls ( dashed lines and open symbols ).

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Source: PubMed

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