Highlights
- •Mortality in ARDS is evaluated at 40%.
- •No curative treatment has been found since its first publication in 1976.
- •Neuromuscular Blockers could show a potential effect.
- •Lower sedation levels could also be a beneficial factor on lowering mortality.
Abstract
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.
Keywords
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Article info
Publication history
Published online: October 12, 2022
Accepted:
October 5,
2022
Received in revised form:
August 12,
2022
Received:
June 27,
2022
Footnotes
Funding:
This study obtained no funding.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
