Neuromuscular Blocking Agents and Neuromuscular Dysfunction Acquired in Critical Illness: A Systematic Review and Meta-Analysis

Price, David; Mikkelsen, Mark E.; Umscheid, Craig A.; Armstrong, Ehrin J.

doi:10.1097/ccm.0000000000001839

Cited by 65 publications

(50 citation statements)

References 38 publications

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“…As there have been more additional relevant studies published, we incorporated the additional recent studies and adopted different inclusion criteria and quality assessment methods in our review. A modest association between the use of NMBAs and ICUAW was found in a previous meta‐analysis without adjustment for potential confounders. In the review, we demonstrate a significant association between the use of NMBAs and ICUAW based on multivariate analysis.…”

Section: Discussionmentioning

confidence: 79%

Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis

et al. 2018

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Intensive care unit-acquired weakness (ICUAW) occurs frequently in the context of critical illness without alternative plausible cause and specific treatment options, and it is important to identify and summarize the independent risk factors for ICUAW. PubMed, Embase, Central, China Biological Medicine, China National Knowledge Infrastructure, VIP and Wanfang databases were searched from database inception until 10 July 2017. Prospective cohort studies on adult ICU patients who were diagnosed with ICUAW using either clinical or electrophysiological criteria were selected. Meta-analysis was performed using Stata version 12.0. The results were analysed using odds ratios (OR) and 95% confidence intervals (CI). Data were pooled using a random-effects model, and heterogeneity was assessed using the I statistic. Qualitative analysis and systematic review were used for risk factors that were deemed inappropriate to combine. Fourteen prospective cohort studies were included in this review. The meta-analysis showed that Acute Physiology and Chronic Health Evaluation II score (OR, 1.05; 95%CI, 1.01-1.10), neuromuscular blocking agents (OR, 2.03; 95%CI, 1.22-3.40) and aminoglycosides (OR, 2.27; 95%CI, 1.07-4.81) were found to be significantly associated with ICUAW. Other risk factors, including female, multiple organ failure, systemic inflammatory response syndrome, sepsis, electrolyte disturbances, hyperglycaemia, hyperosmolarity, high lactate level, duration of mechanical ventilation, parenteral nutrition and use of norepinephrine, were statistically significant on multivariable analysis in each single studies. This review provides a number of independent risk factors for ICUAW, which should be guided for early prediction and prevention of the disorder.

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Section: Discussionmentioning

confidence: 79%

Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis

et al. 2018

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“…An infusion could be considered to control IAP while definitive therapy is sought. Although neuromuscular blocking agents were previously implicated in the development of critical illness polyneuropathy and myoneuropathy, pooled data suggest a more modest association . Nonetheless, we do not advocate for the routine use of paralytics in patients with an open abdomen and recommend caution when considering prolonged neuromuscular blockade (>24‐48 hours).…”

Section: Nonsurgicalmentioning

confidence: 79%

“…Although neuromuscular blocking agents were previously implicated in the development of critical illness polyneuropathy and myoneuropathy, pooled data suggest a more modest association. 34 Nonetheless, we do not advocate for the routine use of paralytics An analgesic agent should be prescribed first, followed by sedatives only if required. 35 Deeper sedation may be needed to prevent forceful Valsalva maneuvers and evisceration in some patients.…”

Section: Improve Abdominal Wall Compliancementioning

confidence: 99%

Management of peripartum intra‐abdominal hypertension and abdominal compartment syndrome

Lozada

Goyal

Levin

et al. 2019

Acta Obstet Gynecol Scand

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Normal pregnancy leads to a state of chronically increased intra‐abdominal pressure. Obstetric and non‐obstetric conditions may increase intra‐abdominal pressure further, causing intra‐abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state‐of‐the‐art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra‐abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.

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“…Cisatracurium was not associated with the risk of ICU-acquired weakness. Although neuromuscular blocker has been widely used, there is still a concern regarding their use in clinical practice [37], especially when concomitant use of corticosteroids for severe septic shock could have an additive effect with NMBA [14]. Our finding of no risk of ICU-acquired weakness is likely because of the short duration of neuromuscular blocker of only 48 h in all the studies.…”

Section: Discussionmentioning

confidence: 59%

Neuromuscular blockade in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

Patolia

Guervilly

2020

j intensive care

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Background: Neuromuscular blocking agent (NMBA) has been proposed by medical guidelines for early severe acute respiratory distress syndrome (ARDS) because of its survival benefits. However, new studies have provided evidence contradicting these results. Method: A search was performed of the Pubmed, Scopus, Clinicaltrials.gov, and Virtual Health Library databases for randomized controlled trials (RCT) evaluating 28-day mortality in ARDS patients treated with NMBA within 48 h. An English language restriction was applied. Relevant data were extracted and pooled into risk ratios (RR), mean differences (MD), and corresponding 95% confidence intervals (CI) using random-effect model. Sensitivity and metaregression analysis were performed. Results: From 2675 studies, we included five RCTs in the analysis, for a total of 1461 patients with a mean PaO 2 / FIO 2 of 104 ± 35 mmHg. The cisatracurium group had the same risk of death at 28 days (RR, 0.90; 95% CI, 0.78-1.03; I 2 = 50%, p = 0.12) and 90 days (RR, 0.81; 95% CI, 0.62-1.06; I 2 = 56%, p = 0.06) as the control group (no cisatracurium). The secondary outcomes of mechanical ventilation duration and ventilator-free days were not different between the two groups. Cisatracurium had a significantly lower risk of barotrauma than the control group with no difference in intensive care unit (ICU)-induced weakness. The PaO 2 /FIO 2 ratio was higher in the cisatracurium group but not until 48 h. Meta-regression analysis of the baseline PaO 2 /FIO 2 ratio, positive endexpiratory pressure (PEEP) revealed no heterogeneity. Subgroup analysis excluding the trial using high PEEP and light sedation strategy yielded an improvement in all mortality outcomes. Conclusion: NMBA improves oxygenation only after 48 h in moderate, severe ARDS patients and has a lower barotrauma risk without affecting ICU weakness. However, NMBA does not reduce ventilator-free days, duration of mechanical ventilation or, most importantly, the mortality risk regardless of the severity of ARDS.

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Neuromuscular Blocking Agents and Neuromuscular Dysfunction Acquired in Critical Illness: A Systematic Review and Meta-Analysis

Cited by 65 publications

References 38 publications

Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis

Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis

Management of peripartum intra‐abdominal hypertension and abdominal compartment syndrome

Neuromuscular blockade in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

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