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

被引:40
作者
Serpa Neto, Ary [1 ]
Moura Pereira, Victor Galvao [1 ]
Esposito, Daniel Crepaldi [1 ]
Toledo Damasceno, Maria Cecilia [1 ]
Schultz, Marcus J. [2 ,3 ]
机构
[1] ABC Med Sch FMABC, Med Intens Care Unit, BR-2000 Santo Andre, Brazil
[2] Univ Amsterdam, Acad Med Ctr, Dept Intens Care Med, NL-1105 AZ Amsterdam, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, Lab Expt Intens Care & Anesthesiol, NL-1105 AZ Amsterdam, Netherlands
来源
ANNALS OF INTENSIVE CARE | 2012年 / 2卷
关键词
ARDS; Neuromuscular blocking agents; Meta-analysis; Review; INTENSIVE-CARE-UNIT; BLOCKADE;
D O I
10.1186/2110-5820-2-33
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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 FiO(2) 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.
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页数:8
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