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

Neto AS, Pereira VG, Espósito DC, Damasceno MC, Schultz MJ - Ann Intensive Care (2012)

Bottom Line: Systematic review and meta-analysis of publications between 1966 and 2012.The incidence of critical illness neuromyopathy was similar (p = 0.540).The use of NMBA in the early phase of ARDS improves outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Intensive Care Unit, ABC Medical School (FMABC), Av, Lauro Gomes, Santo André, 2000, Brazil. aryserpa@terra.com.br.

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.

No MeSH data available.


Related in: MedlinePlus

Literature search strategy.
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Figure 1: Literature search strategy.

Mentions: 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. During this review, 11 articles were excluded for the following reasons: letter to editor (n = 5); non-randomized trial (n = 3); review article (n = 2); and case report (n = 1). Finally, three articles (431 participants) were included in the final analysis [3,7,8] (Figure 1).


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

Neto AS, Pereira VG, Espósito DC, Damasceno MC, Schultz MJ - Ann Intensive Care (2012)

Literature search strategy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475105&req=5

Figure 1: Literature search strategy.
Mentions: 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. During this review, 11 articles were excluded for the following reasons: letter to editor (n = 5); non-randomized trial (n = 3); review article (n = 2); and case report (n = 1). Finally, three articles (431 participants) were included in the final analysis [3,7,8] (Figure 1).

Bottom Line: Systematic review and meta-analysis of publications between 1966 and 2012.The incidence of critical illness neuromyopathy was similar (p = 0.540).The use of NMBA in the early phase of ARDS improves outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Intensive Care Unit, ABC Medical School (FMABC), Av, Lauro Gomes, Santo André, 2000, Brazil. aryserpa@terra.com.br.

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.

No MeSH data available.


Related in: MedlinePlus