Medical Intensive Care Unit, ABC Medical School (FMABC), Av, Lauro Gomes, Santo André, 2000, Brazil.
Ann Intensive Care. 2012 Jul 26;2(1):33. doi: 10.1186/2110-5820-2-33.
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.
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.
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 FiO2 ratios (p = 0.004), and less barotraumas (p = 0.030). The incidence of critical illness neuromyopathy was similar (p = 0.540).
The use of NMBA in the early phase of ARDS improves outcome.
急性呼吸窘迫综合征（ARDS）是一种具有高死亡率的潜在致命疾病。我们的目的是总结目前在 ARDS 早期使用神经肌肉阻滞剂（NMBA）的证据。
对 1966 年至 2012 年间发表的文献进行系统评价和荟萃分析。在 Medline 和 CENTRAL 数据库中搜索关于 ARDS 患者 NMBA 的研究。荟萃分析仅限于：1）随机对照试验；02）成人 ARDS 或急性肺损伤患者；03）研究中一组使用任何 NMBA 与另一组不使用 NMBA 进行比较。评估的结果包括：总死亡率、无呼吸机天数、机械通气时间、不良事件、气体交换变化、呼吸机设置变化和呼吸力学变化。
纳入了三项随机对照试验，共 431 名参与者。接受 NMBA 治疗的患者死亡率较低（风险比，0.71 [95%可信区间，0.55-0.90]；需要治疗的人数，1-7），第 28 天无呼吸机天数更多（p=0.020），PaO2/Fio2 比值更高（p=0.004），气压伤更少（p=0.030）。严重疾病神经肌肉病的发生率相似（p=0.540）。
ARDS 早期使用 NMBA 可改善预后。
