The use of early neuromuscular blockage in acute respiratory distress syndrome: A systematic review and meta-analyses of randomized clinical trials.

Autor: Savoie-White FH; Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada; Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Canada; Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada. Electronic address: felix.savoie-white.1@ulaval.ca., Tremblay L; Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada., Menier CA; Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada., Duval C; Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Canada., Bergeron F; Bibliothèque de l'Université Laval, Québec, Québec, Canada., Tadrous M; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada., Tougas J; Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada., Guertin JR; Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada; Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada., Ugalde PA; Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard University, Cambridge, Boston, United States.
Jazyk: angličtina
Zdroj: Heart & lung : the journal of critical care [Heart Lung] 2023 Jan-Feb; Vol. 57, pp. 186-197. Date of Electronic Publication: 2022 Oct 12.
DOI: 10.1016/j.hrtlng.2022.10.001
Abstrakt: Background: Acute Respiratory Distress Syndrome (ARDS) as defined by the Berlin definition has an approximate mortality rate of 40% and no curative treatment. Mutliple therapies have been studied to reduce mortality but only neuromuscular blocking agents show potential benefits on mortality and other complications of ARDS.
Objective: This review aimed to investigate the efficacy of neuromuscular blockers in ARDS METHODS: Medline, Embase, Cochrane Central and Web of Science were queried on October 1st, 2021. Randomized clinical trials comparing neuromuscular blockers to any comparator in treating ARDS were included. Primary outcome was mortality. Secondary outcomes were ventilator-free days, intensive care (ICU) length of stay (LOS) and complications. Results between sedation levels were examined with a Bayesian Network for Meta-analysis method.
Results: We included 6 trials compiling a total of 1557 patients. Neuromuscular blockers compared to any comparator in treating ARDS showed a reduction in mortality (RR 0.79 [95% CI, 0.62 to 0.99]). No difference in ventilator-free days (MD 0.68 [95% CI, -0.50 to 1.85]) or ICU LOS (MD 0.77 [95% CI, -2.99 to 4.54]) were found. A Bayesian Network Meta-analysis yielded no difference in mortality when using light sedation compared to heavy sedation in ARDS. (OR 0.58 [95% CrI, 0.07 to 4.46].) CONCLUSION: Neuromuscular blockers safely reduce mortality. Light sedation potentially has a similar impact on mortality as heavy sedation that carries some burden. A non-inferiority trial comparing both sedation levels may be warranted considering the added value of light sedation.
Competing Interests: Declaration of Competing Interest No authors must declare any conflict of interest.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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