Effects of the use of neuromuscular blocking agents on acute respiratory distress syndrome outcomes

A systematic review

Abstract

Background and purpose: 

Acute respiratory distress syndrome (ARDS) is a high-mortality disease with limited treatment options. Optimization of gas exchange while limiting damage to the lungs is key. The use of neuromuscular blocking agents may limit hypoxemia while preventing ventilator-induced lung injury.

Methods: 

A literature search was conducted using Ovid Medline and the exploded MeSH terms ARDS, acute respiratory distress syndrome, neuromuscular blockade, neuromuscular blocking agents, and paralytics. With limitations applied, three original randomized controlled trials investigating the use of neuromuscular blocking agents (NMBAs) in severe ARDS were identified and reviewed.

Conclusions: 

Two of the three trials demonstrated improved primary outcomes with the use of NMBA. The third trial was underpowered (due to unanticipated low mortality in the control group) and did not show a statistically significant improvement in the primary outcome. As all the original research was conducted by the same group, further investigation is necessary to assess generalizability and confirm results. Currently, additional research is underway, focusing on early enrollment and narrow inclusion criteria.

Implications for practice: 

Secondary analysis from two separate groups concluded the improved outcomes, with no evidence of increased risk of critical illness polyneuropathy or myopathy, suggest that the use of NMBAs in severe ARDS is appropriate.