Abstract
BackgroundAcute 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.MethodsSystematic 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.ResultsThree 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).ConclusionsThe use of NMBA in the early phase of ARDS improves outcome.
Highlights
Acute respiratory distress syndrome (ARDS) is a potentially fatal disease with high mortality
Literature search and data extraction The online database of MedLine (1966 – 2012) and Cochrane Register of Controlled Trials were searched for studies that fulfill the following inclusion criteria: 1) randomized controlled trials; 02) adult human patients with ARDS or acute lung injury (AECC criteria in the first 48 hours); [5] and 03) use of any neuromuscular blocking agents (NMBA) in one arm of the study compared with another arm without NMBA
The comprehensive literature search yielded 60 references, of which 46 articles were excluded during the first screening, which was based on abstracts or titles, leaving 14 articles for full text review
Summary
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. Acute respiratory distress syndrome (ARDS) is a potentially fatal disease with high mortality even with the use of protective ventilation strategy [1]. Papazian et al [3] showed that the use of a neuromuscular blocking agent (NMBA) early in the course of ARDS improves the overall survival and.
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