Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

• Type of Material: Article
• Authors: Waleed Alhazzani, McMaster University Medical Centre; Mohamed Alshahrani, King Fahad Hospital; Roman Jaeschke, McMaster University; Jean Marie Forel, Aix-Marseille University; Laurent Papazian, Aix-Marseille University; Jonathan Sevransky, Emory University; Maureen O Meade, McMaster University
• Language: English
• Date: 2013-01-01
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Alhazzani et al.; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.1186/cc12557
• Title of Journal or Parent Work: Critical Care
• ISSN: 1364-8535
• Volume: 17
• Issue: 2
• Start Page: R43
• End Page: R43
• Grant/Funding Information: Laurent Papazian received grants for ACURASYS trial from GlaxoSmithKline and honoraria for advice or public speaking for Faron (June 2011).
• Keywords: BLOCKADE; CONSENSUS; Life Sciences & Biomedicine; ACQUIRED WEAKNESS; VENTILATION; NATIONAL-SURVEY; OUTCOMES; Science & Technology; ACUTE LUNG INJURY; General & Internal Medicine; Pulmonary; BIAS; CRITICAL CARE MEDICINE; RISK; Critical Care Medicine
• Research Categories: Health Sciences, Health Care Management; Health Sciences, General

Abstract

Introduction: Randomized trials investigating neuromuscular blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness.Methods: We conducted a systematic review and meta-analysis. We searched the Cochrane (Central) database, MEDLINE, EMBASE, ACP Journal Club, and clinical trial registries for randomized trials investigating survival effects of neuromuscular blocking agents in adults with ARDS. Two independent reviewers abstracted data and assessed methodologic quality. Primary study investigators provided additional unpublished data.Results: Three trials (431 patients; 20 centers; all from the same research group in France) met inclusion criteria for this review. All trials assessed 48-hour infusions of cisatracurium besylate. Short-term infusion of cisatracurium besylate was associated with lower hospital mortality (RR, 0.72; 95% CI, 0.58 to 0.91; P = 0.005; I2 = 0). This finding was robust on sensitivity analyses. Neuromuscular blockade was also associated with lower risk of barotrauma (RR, 0.43; 95% CI, 0.20 to 0.90; P = 0.02; I2 = 0), but had no effect on the duration of mechanical ventilation among survivors (MD, 0.25 days; 95% CI, 5.48 to 5.99; P = 0.93; I2 = 49%), or the risk of ICU-acquired weakness (RR, 1.08; 95% CI, 0.83 to 1.41; P = 0.57; I2 = 0). Primary studies lacked protracted measurements of weakness.Conclusions: Short-term infusion of cisatracurium besylate reduces hospital mortality and barotrauma and does not appear to increase ICU-acquired weakness for critically ill adults with ARDS.