Cited by 250Respiratory Support and MechanismsIntensive Care Unit Cognitive DisordersAnesthesia and Sedative Agents

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

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Alhazzani, Waleed, Alshahrani, Mohamed, Jaeschke, Roman, Forel, Jean Marie, Papazian, Laurent, Sevransky, Jonathan, Meade, Maureen O·2013·Critical Care

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 Primary study investigators provided additional unpublished data.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; I 2 = 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; I 2 = 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; I 2 = 49%), or the risk of ICU-acquired weakness (RR, 1.08; 95% CI, 0.83 to 1.41; P = 0.57; I 2 = 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.

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  • This recommendation was based on a meta-analysis of 3 trials that examined the role of NMBAs in ARDS, showing reduced risks of death (RR 0.72; 95% CI 0.58-0.91) and barotrauma (RR 0.43; 95% CI 0.20-0.90) with the use of cisatracurium infusion.

    “This recommendation was based on a meta-analysis of 3 trials that examined the role of NMBAs in ARDS [465–467], showing reduced risks of death (RR 0.72; 95% CI 0.58–0.91) and barotrauma (RR 0.43; 95% CI 0.20–0.90) with the use of cisatracurium infusion [468].”

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Authors
Alhazzani, W., Alshahrani, M., Jaeschke, R., Forel, J. M., Papazian, L., Sevransky, J., & Meade, M. O.
Affiliations
  • McMaster University Medical Centre (CA)
  • Centre National de la Recherche Scientifique (FR)
  • Johns Hopkins University (US)
Corresponding author
Alhazzani, Waleed
Venue
Critical Care
Published
2013-03-11
Volume
17
Issue
2
Pages
R43-R43
ISSN
1364-8535 (ISSN-L)
OpenAlex
W2169283873
Cited by
250
References
32
Citations by year
2026: 8 · 2025: 5 · 2024: 8 · 2023: 8 · 2022: 14 · 2021: 21 · 2020: 42 · 2019: 22 · 2018: 15 · 2017: 30 · 2016: 31 · 2015: 24 · 2014: 14 · 2013: 7
FWCI
3.93
Type
journal article
Language
en
Open access
Locations
  • Critical Care (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Keywords
neuromuscular blocking agents, acute respiratory distress syndrome, in-hospital mortality, barotrauma, ICU-acquired weakness, mechanical ventilation duration, critically ill adults
MeSH terms
Atracurium, Humans, Neuromuscular Blocking Agents, Respiration, Artificial, Respiratory Distress Syndrome, Randomized Controlled Trials as Topic

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