[A meta-analysis of the effect of neuromuscular blocking agents on oxygenation in patients with acute respiratory distress syndrome]

Abstract

Objective: To evaluate the effects of neuromuscular blocking agents (NMBA) on oxygenation and respiratory conditions in patients with acute respiratory distress syndrome(ARDS). Methods: English databases such as MEDLINE, Embase and Web of Science were searched online, as well as Chinese databases such as China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database and Wanfang Database. Randomized controlled trials (RCTs) of NMBA therapy for ARDS with publication date up to May 2020 were retrieved. Literature was screened according to inclusion and exclusion criteria, and the main analysis indicators were oxygenation index. Results: A total of 5 RCTs were included, and 1 462 ARDS patients were enrolled. Compared with the control group, the ratio of partial arterial oxygen pressure to fraction of inspired (PaO₂)/(FiO₂) significantly improved in the intervention group after 72 hours MD=14.39, (95%CI 6.40-22.38, P=0.000 4) and 96 hours of NMBA, but there was no difference between PaO₂/FiO₂ at 24 and 48 hours (P>0.05).Positive end expiratory pressure (PEEP) significantly decreased at 72 hours (MD=-0.45, 95%CI -0.87--0.03, P=0.04) and 96 hours (MD=-0.82, 95%CI -1.39--0.26, P=0.004) treatment with NMBA, while there was no significant difference in PEEP between 24 and 48 hours after treatment (P>0.05). At 96 h, plateau pressure (Pplat) in the intervention group was significantly lower (MD=-1.69, 95%CI -2.64--0.75, P=0.000 4), and there was no significant difference in Pplat between 24, 48 and 72 h after treatment (P>0.05). Conclusion: The early use of NMBA within 48 hours has a delayed improvement effect on oxygenation and ventilator conditions in ARDS patients.