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Published on: September 24, 2020
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Neuromuscular Blocking Agents for ARDS: A Systematic Review and Meta-Analysis
Heather Torbic1, Sudhir Krishnan2, Mary Pat Harnegie3
1Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. torbich@ccf.org.
Respiratory Care
|August 27, 2020
Summary
Early use of neuromuscular blocking agents (NMBAs) in acute respiratory distress syndrome (ARDS) reduces short-term mortality and ventilator-induced lung injury. However, NMBAs do not impact long-term survival and should be used judiciously in select ARDS patients.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Pharmacology
Background:
- Neuromuscular blocking agents (NMBAs) have shown inconsistent effects on mortality in acute respiratory distress syndrome (ARDS) management.
- Previous studies yielded conflicting results regarding NMBA efficacy in ARDS patients.
Purpose of the Study:
- To conduct a systematic review and meta-analysis.
- To evaluate mortality differences between ARDS patients receiving NMBAs versus placebo or usual care.
Main Methods:
- Systematic search of multiple databases (Ovid, MEDLINE, Embase, CINAHL, Cochrane, Scopus, Web of Science).
- Inclusion of randomized controlled trials (RCTs) evaluating NMBA administration in ARDS.
- Analysis of data from 6 RCTs involving 1,558 subjects.
Main Results:
- Early, continuous-infusion NMBAs reduced short-term (21-28 day) mortality (RR 0.71; 95% CI 0.52-0.98).
- NMBAs did not significantly reduce long-term (90-day) mortality (RR 0.81; 95% CI 0.64-1.04).
- NMBAs decreased the risk of barotrauma (RR 0.55; 95% CI 0.35-0.85) and pneumothorax (RR 0.46; 95% CI 0.28-0.77).
Conclusions:
- Early NMBA use in ARDS improves oxygenation and reduces ventilator-induced lung injury.
- NMBA administration is associated with decreased 21-28 day mortality but not 90-day mortality.
- Consider NMBAs for short durations in select moderate-to-severe ARDS patients.
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