Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Critical Care, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
PLoS One. 2020 Jan 21;15(1):e0227664. doi: 10.1371/journal.pone.0227664. eCollection 2020.
The effects of neuromuscular blocking agents (NMBAs) on adult patients with acute respiratory distress syndrome (ARDS) remain unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate its effect on mortality.
We searched the Cochrane (Central) database, Medline, Embase, the Chinese Biomedical Literature Database (SinoMed), WanFang data and ClinicalTrials from inception to June 2019, with language restriction to English and Chinese. We included published RCTs and eligible clinical trials from ClinicalTrials.gov that compared NMBAs with placebo or usual treatment in adults with ARDS. We pooled data using random-effects models. The primary outcome was mortality. The secondary outcomes were the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FIO2), total positive end expiratory pressure (PEEP), plateau pressure (Pplat), days free of ventilator at day 28, barotrauma and ICU-acquired weakness.
We included 6 RCTs (n = 1557). Compared with placebo or usual treatment, NMBAs were associated with lower 21 to 28-day mortality (RR 0.72, 95% CI 0.53-0.97, I2 = 59%). NMBAs significantly improved oxygenation (Pao2:Fio2 ratios) at 48 hours (MD 27.26 mm Hg, 95% CI 1.67, 52.84, I2 = 92%) and reduced the incidence of barotrauma (RR 0.55, 95% CI 0.35, 0.85, I2 = 0). However, NMBAs had no effect on oxygenation (Pao2:Fio2 ratios) (MD 18.41 mm Hg, 95% CI -0.33, 37.14, I2 = 72%) at 24 hours. We also found NMBAs did not affect total PEEP, plateau pressure, days free of ventilation at day 28 and ICU-acquired weakness.
In patients with moderate-to-severe ARDS, the administration of NMBAs could reduce 21 to 28-day mortality and barotrauma, and improve oxygenation at 48 hours, but have no significant effects on 90-day/ICU mortality, days free of ventilation at day 28 and the risk of ICU-acquired weakness. Further large-scale, high-quality RCTs are needed to confirm our findings. Registration: PROSPERO (ID: CRD 42019139656).
神经肌肉阻滞剂（NMBAs）对急性呼吸窘迫综合征（ARDS）成年患者的影响仍不清楚。我们进行了一项荟萃分析，评估了随机对照试验（RCTs）对死亡率的影响。
我们检索了 Cochrane（中央）数据库、Medline、Embase、中国生物医学文献数据库（SinoMed）、万方数据和 ClinicalTrials，检索时间从成立到 2019 年 6 月，语言限制为英语和中文。我们纳入了比较 ARDS 成人使用 NMBAs 与安慰剂或常规治疗的已发表 RCTs 和来自 ClinicalTrials.gov 的合格临床试验。我们使用随机效应模型汇总数据。主要结局是死亡率。次要结局是动脉血氧分压与吸入氧分数之比（PaO2/FIO2）、总呼气末正压（PEEP）、平台压（Pplat）、第 28 天无呼吸机天数、气压伤和 ICU 获得性肌无力。
我们纳入了 6 项 RCTs（n = 1557）。与安慰剂或常规治疗相比，NMBAs 与 21 至 28 天死亡率降低相关（RR 0.72，95%CI 0.53-0.97，I2 = 59%）。NMBAs 可显著改善 48 小时的氧合（Pao2:Fio2 比值）（MD 27.26mmHg，95%CI 1.67，52.84，I2 = 92%）和降低气压伤发生率（RR 0.55，95%CI 0.35，0.85，I2 = 0）。然而，NMBAs 对 24 小时的氧合（Pao2:Fio2 比值）无影响（MD 18.41mmHg，95%CI -0.33，37.14，I2 = 72%）。我们还发现，NMBAs 对总 PEEP、平台压、第 28 天无通气天数和 ICU 获得性肌无力无影响。
在中重度 ARDS 患者中，使用 NMBAs 可降低 21 至 28 天死亡率和气压伤发生率，并改善 48 小时氧合，但对 90 天/ICU 死亡率、第 28 天无通气天数和 ICU 获得性肌无力的风险无显著影响。需要进一步开展大规模、高质量的 RCT 来证实我们的发现。注册：PROSPERO（ID：CRD42019139656）。
