The Use of Paralytics in Patients with Acute Respiratory Distress Syndrome

Hraiech, Sami; Dizier, Stéphanie; Papazian, Laurent

doi:10.1016/j.ccm.2014.08.012

Cited by 10 publications

(12 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the present study, we did not find shortterm use of NMBAs could increase the incidence of ICU-obtained weakness. However, the diagnosis of ICU-obtained weakness is inconsistent and subjective and many other factors can affect the incidence of ICU-acquired weakness [34,35]. Besides, the ROSE trial found use of cisatracurium is associated with a higher risk of serious cardiovascular events [16].…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular blocking agents for acute respiratory distress syndrome: an updated meta-analysis of randomized controlled trials

et al. 2020

View full text Add to dashboard Cite

Backgrounds:The aim of this study is investigating the benefits and harms of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS). Methods:We comprehensively searched PubMed, EMBASE, and Cochrane library for randomized controlled trials comparing NMBAs to any other comparator. We pooled data using relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes, with 95% confidence intervals. We assessed the quality of included studies using the Cochrane tool and levels of evidence using the GRADE method.Results: Finally, six RCTs (n = 1557 patients) were eligible for analysis. The results showed NMBAs use was not associated with reduced 28 days mortality (RR 0.78; 95% CI, 0.58 to 1.06; P = 0.11), 90 days mortality (RR, 0.92; 95% CI, 0.81 to 1.04; P = 0.16), and intensive care unit (ICU) mortality (RR, 0.90; 95% CI, 0.79 to 1.03; P = 0.13) in patients with ARDS. However, 21-28 days mortality was slightly lower in patients received NMBAs (RR 0.73; 95% CI, 0.54 to 0.99; P = 0.04; I 2 = 53%). Besides, NMBAs use could improve the PaO 2 /FiO 2 ratio at 48 and 72 h, decrease plateau pressure and PEEP at 72 h. Additionally, NMBAs had no significant effects on days free of ventilation at day 28 (WMD, 0.55; 95% CI, − 0.46 to 1.57; P = 0.29), days not in ICU at day 28 (WMD, 0.12; 95% CI, − 0.85 to 1.08; P = 0.82), ICU-acquired weakness (RR, 1.23; 95% CI, 0.99 to 1.93; P = 0.06). Finally, NMBAs use was associated with a lower risk of barotrauma (RR, 0.55; 95% CI, 0.35 to 0.85; P = 0.007). Conclusion:In patients with respiratory distress syndrome, NMBAs may be beneficial in reverse refractory hypoxemia and may be associated with reduced short-term mortality and incidence of barotrauma. However, there is no significant effects of NMBAs on mid-term and long-term mortality, and further studies are required.

show abstract

Section: Discussionmentioning

confidence: 99%

Neuromuscular blocking agents for acute respiratory distress syndrome: an updated meta-analysis of randomized controlled trials

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The traditional view on NMBA use in the critical care setting is largely negative, with a number of potential complications associated with this therapeutic modality [38,39]. However, other work over the past 12 years has indicated that use of NMBAs in acute respiratory distress syndrome (ARDS) has been shown to improve oxygenation and decrease mortality in most hypoxemic patients [40]. What is applicable in ARDS is also applicable in ECMO because ECMO is just a further device extension beyond ventilators and high-frequency oscillators [41,42].…”

Section: Neuromuscular Blockade and Ecmo/ardsmentioning

confidence: 99%

“…Physicians must be aware of the potentially important pathophysiological events that can occur with the use of NMBAs in hypoxemic patients [40]. These include increases in thoracopulmonary compliance, functional residual capacity, perfusion of ventilated spaces, and recruitment of portions of the lung that have little compliance.…”

Section: Neuromuscular Blockade and Ecmo/ardsmentioning

confidence: 99%

“…The debate continues as to the best ventilation practices/strategy in ARDS. The problem with NMBAs is that they seem to eliminate the opportunity for the use of spontaneous modes [40].…”

Section: Neuromuscular Blockade and Ecmo/ardsmentioning

confidence: 99%

“…It was associated with independent risk factors such as organ dysfunction, female gender, length of time on a ventilator, and corticosteroid administration [51], and there is some evidence it is related to hypothermia, hyperglycemia, ICU length of stay, low albumin, and vasopressors [52][53][54]. While NMBAs have historically been associated with ICUAW, recent evidence contradicts this view, at least with nonsteroidal NMBAs [40].…”

Section: Neuromuscular Blockade and Ecmo/ardsmentioning

confidence: 99%

See 2 more Smart Citations

Sedation, Analgesia Delirium in the ECMO Patient

Satyapriya¹,

Lyaker²,

Rozycki³

et al. 2016

Extracorporeal Membrane Oxygenation: Advances in Therapy

View full text Add to dashboard Cite

The goal of this chapter is to identify medications frequently utilized for sedation and analgesia in Extracorporeal Membrane Oxygenation ECMO patients. In addition to describing basic pharmacologic principles of these medications, we discuss their benefits and disadvantages and explain the effects the ECMO circuitry will have on pharmacokinetics of each drug. We also discuss need for various depths of sedation and the utility of neuromuscular blocking agents. Emerging techniques for achieving appropriate sedation will be identified. "n explosion of literature in recent years has led to Intensive Care Unit ICU delirium increasingly being recognized as an indicator of poor outcomes in the general ICU population. We discuss strategies to manage this complex and multifactorial issues, and how they can be applied to our particular subpopulation of ECMO patients.

show abstract