title: Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  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 Primary study investigators provided additional unpublished data.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; I2=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; I2=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; I2=49%), or the risk of ICU-acquired weakness (RR, 1.08; 95% CI, 0.83 to 1.41; P=0.57; I2=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.
authors.forename: Waleed
authors.initials: W
authors.lastname: Alhazzani
authors.forename: Mohamed
authors.initials: M
authors.lastname: Alshahrani
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sevransky
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
mesh_terms: D001279:Atracurium / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium