The effect of neuromuscular blocking agents on prognosis of patients with acute respiratory distress syndrome: a meta analysis

Abstract

To determine the effects of neuromuscular blocking agent (NMBA) on prognosis of patients with acute respiratory distress syndrome (ARDS). PubMed database, the Cochrane Library, EMBASE, Excepta Media, CBM, CNKI and other sources were used for retrieving the pertinent literature. All randomized controlled trials (RCTs) on NMBA treating ARDS patients were enrolled. The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. Two authors independently extracted data and assessed study quality using standardized instruments. Three studies were included in the final analysis, providing a sample of 431 patients. The combined results demonstrated a decrease in 28 days mortality [Peto odds ratio (OR) =0.57, 95% confidence interval (95%CI) 0.37-0.88, P=0.01] and lower incidence of barotrauma (OR=0.42, 95%CI 0.20-0.91,P=0.003) after NMBA treatment for patients with ARDS as compared with control group. The incidence of acquired neuromyopathy was similar between NMBA group and control group (OR=1.20, 95%CI 0.67-2.14, P=0.54). As compared with the control group at 48 hours, there was no statistical difference in ventilator parameters including total positive end expiratory pressure (PEEP, OR=0.09, 95%CI -0.50-0.68, P=0.77) and plateau pressure (Pplat, OR=0.62, 95%CI -0.32-1.57, P=0.20). There was no heterogeneity (P>0.1, I (2)<50%). At 120 hours after NMBA treatment, the total PEEP was significantly lower than that of control group (OR=-1.22, 95%CI -2.39 to -0.04, P=0.04), and the difference in Pplat showed statistical difference compared with the control group (OR=-2.61, 95%CI -4.50 to -0.73, P=0.007). Early administration of NMBA for ARDS patients results in a significant reduction in 28 days mortality, and it improves outcome.