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Neuromuscular blocking agents for adult patients with acute respiratory distress syndrome

A meta-analysis of randomized controlled trials

Tao, Wei, MSc; Yang, Liu-Qing, MSc; Gao, Ju, PhD; Shao, Jun, MBBS

Journal of Trauma and Acute Care Surgery: December 2018 - Volume 85 - Issue 6 - p 1102–1109
doi: 10.1097/TA.0000000000002057
SYSTEMATIC REVIEW

BACKGROUND To explore the effect of neuromuscular blocking agents (NMBAs) on adult patients with acute respiratory distress syndrome (ARDS) by meta-analysis.

METHODS Three databases including Cochrane central register of controlled trials, PubMed, and Wanfang Data were searched to find relevant articles. We included randomized controlled trials that evaluated NMBAs compared with placebo or usual treatment in adult patients with ARDS.

RESULTS Five trials totaling 551 patients were identified eligible for inclusion. All the five trials were protective ventilation strategies based. All patients (the ratio of partial pressure of arterial oxygen/fraction of inspired oxygen ≤ 200 mm Hg) met American-European Consensus Conference or the Berlin definition oxygenation criteria for ARDS. Neuromuscular blocking agents significantly reduced intensive care unit mortality (relative risk, 0.73; 95% confidence intervals [CI], 0.58–0.93; p = 0.009; I 2 = 0.0%; 4 trials, 455 patients) and 21- to 28-day mortality (relative risk, 0.63; 95% CI, 0.49–0.82; p = 0.001; I 2 = 0.0%; 4 trials, 527 patients). At 48 hours, NMBAs improved oxygenation (weighted mean differences [WMD], 27.98; 95% CI, 7.45–48.51; p = 0.008; I 2 = 44.2%; 4 trials, 212 patients). However, NMBAs have no effect on reduction of oxygenation at 24 hours (WMD, 26.83; 95% CI, −5.89 to 59.55; p = 0.108; I 2 = 82.4%; 4 trials, 447 patients), and plateau pressure (WMD, 0.43; 95% CI, −0.46 to 1.31; p = 0.345; 4 trials, 455 patients) as well as positive end expiratory pressure (WMD, 0.10; 95% CI, −0.47 to 0.67; p = 0.73; 4 trials, 455 patients) at 48 hours.

CONCLUSION Protective ventilation strategies based NMBAs treatment reduces mortality in patients with moderate to severe ARDS.

LEVEL OF EVIDENCE Systematic reviews & meta-analysis, level III.

From the Department of Surgery (W.T.), Department of Anesthesiology (L-Q.Y., J.G.), and Department of Outpatient (J.S.), Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China.

Submitted: May 7, 2018, Accepted: August 15, 2018, Published online: September 6, 2018.

Address for reprints: Wei Tao, Department of Surgery, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, No. 98, Nantong West Road, Yangzhou, Jiangsu, China; email: 1153680150@qq.com; Jun Shao, Department of Outpatient, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, No. 98, Nantong West Rd, Yangzhou, Jiangsu, China; email: Sbrm_88@aliyun.com.

© 2018 Lippincott Williams & Wilkins, Inc.