Limits...
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

Changes in PaO2/ FiO2( circles ), plateau pressure ( triangles ) and PEEP (squares ) between patients under NMBA ( continuous line and closed symbols ) and controls ( dashed lines and open symbols ).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3475105&req=5

Figure 3: Changes in PaO2/ FiO2( circles ), plateau pressure ( triangles ) and PEEP (squares ) between patients under NMBA ( continuous line and closed symbols ) and controls ( dashed lines and open symbols ).

Mentions: PaCO2 levels, tidal volume, and plateau pressure were similar in both groups at the final follow-up (p = 0.800, p = 0.850, and p = 0.250, respectively). There was a trend to the use of lower PEEP levels in patients under NMBA (p = 0.060), and even with the same tidal volume, patients treated with NMBA had lower plateau pressure at final follow-up, although this not reached significance (p = 0.250). However, when we assessed the changes of the variables during the follow-up (last value of the follow-up – baseline values) we founded a higher decrease in PEEP levels (− 2.20 ± 1.90 vs. - 0.46 ± 0.56, for NMBA and controls, respectively; p = 0.050), and in plateau pressure (− 3.66 ± 1.49 vs. - 0.70 ± 0.60, for NMBA and controls, respectively; p = 0.050). (Table 2). One day after the final of infusion (72 hours) patients in the NMBA group presented a higher increase in PaO2 / FiO2 ratio and a higher decrease in the plateau pressure (Table 4 and Figure 3).


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)

Changes in PaO2/ FiO2( circles ), plateau pressure ( triangles ) and PEEP (squares ) between patients under NMBA ( continuous line and closed symbols ) and controls ( dashed lines and open symbols ).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Changes in PaO2/ FiO2( circles ), plateau pressure ( triangles ) and PEEP (squares ) between patients under NMBA ( continuous line and closed symbols ) and controls ( dashed lines and open symbols ).
Mentions: PaCO2 levels, tidal volume, and plateau pressure were similar in both groups at the final follow-up (p = 0.800, p = 0.850, and p = 0.250, respectively). There was a trend to the use of lower PEEP levels in patients under NMBA (p = 0.060), and even with the same tidal volume, patients treated with NMBA had lower plateau pressure at final follow-up, although this not reached significance (p = 0.250). However, when we assessed the changes of the variables during the follow-up (last value of the follow-up – baseline values) we founded a higher decrease in PEEP levels (− 2.20 ± 1.90 vs. - 0.46 ± 0.56, for NMBA and controls, respectively; p = 0.050), and in plateau pressure (− 3.66 ± 1.49 vs. - 0.70 ± 0.60, for NMBA and controls, respectively; p = 0.050). (Table 2). One day after the final of infusion (72 hours) patients in the NMBA group presented a higher increase in PaO2 / FiO2 ratio and a higher decrease in the plateau pressure (Table 4 and Figure 3).

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