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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

Effect of neuromuscular blockade in patients with ARDS at the end of the follow-up period for each study.
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Figure 2: Effect of neuromuscular blockade in patients with ARDS at the end of the follow-up period for each study.

Mentions: Seventy out of 223 patients (31.4 %) assigned to neuromuscular blockade and 93 out of 208 patients (44.7 %) assigned as controls died during ICU stay (Risk ratio [RR], 0.71 [95 % CI, 0.55 – 0.90]; number needed to treat [NNT], 1 – 7). After analyzed 385 patients from two studies [3,7], this finding was similar after 28 days of follow-up (RR, 0.69 [95 % CI, 0.51 – 0.92]; NNT, 1 – 8). Patients treated with NMBA needed less days of mechanical ventilation with a higher number of ventilator-free days at day 28 (p = 0.0020). At the final of follow-up, patients treated with NMBA showed an increase in PaO2 to FiO2 ratio (p = 0.004), at lower FiO2 (p = 0.002). The incidence of barotrauma was lower in patients under neuromuscular blockade (p = 0.030) while the incidence of critical illness neuromyopathy was similar in both groups (p = 0.540). (Table 3 and Figure 2).


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)

Effect of neuromuscular blockade in patients with ARDS at the end of the follow-up period for each study.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Effect of neuromuscular blockade in patients with ARDS at the end of the follow-up period for each study.
Mentions: Seventy out of 223 patients (31.4 %) assigned to neuromuscular blockade and 93 out of 208 patients (44.7 %) assigned as controls died during ICU stay (Risk ratio [RR], 0.71 [95 % CI, 0.55 – 0.90]; number needed to treat [NNT], 1 – 7). After analyzed 385 patients from two studies [3,7], this finding was similar after 28 days of follow-up (RR, 0.69 [95 % CI, 0.51 – 0.92]; NNT, 1 – 8). Patients treated with NMBA needed less days of mechanical ventilation with a higher number of ventilator-free days at day 28 (p = 0.0020). At the final of follow-up, patients treated with NMBA showed an increase in PaO2 to FiO2 ratio (p = 0.004), at lower FiO2 (p = 0.002). The incidence of barotrauma was lower in patients under neuromuscular blockade (p = 0.030) while the incidence of critical illness neuromyopathy was similar in both groups (p = 0.540). (Table 3 and Figure 2).

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