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Neuromuscular blocking agents in patients with acute respiratory distress syndrome: a summary of the current evidence from three randomized controlled trials

Ary Serpa Neto1*, Victor Galvão Moura Pereira1, Daniel Crepaldi Espósito1, Maria Cecília Toledo Damasceno1 and Marcus J Schultz2

Author Affiliations

1 Medical Intensive Care Unit, ABC Medical School (FMABC), Av. Lauro Gomes, Santo André, 2000, Brazil

2 Department of Intensive Care Medicine & Laboratory of Experimental Intensive Care and Anesthesiology; Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Annals of Intensive Care 2012, 2:33  doi:10.1186/2110-5820-2-33

Published: 26 July 2012



Acute respiratory distress syndrome (ARDS) is a potentially fatal disease with high mortality. Our aim was to summarize the current evidence for use of neuromuscular blocking agents (NMBA) in the early phase of ARDS.


Systematic review and meta-analysis of publications between 1966 and 2012. The Medline and CENTRAL databases were searched for studies on NMBA in patients with ARDS. The meta-analysis was limited to: 1) randomized controlled trials; 02) adult human patients with ARDS or acute lung injury; and 03) use of any NMBA in one arm of the study compared with another arm without NMBA. The outcomes assessed were: overall mortality, ventilator-free days, time of mechanical ventilation, adverse events, changes in gas exchange, in ventilator settings, and in respiratory mechanics.


Three randomized controlled trials covering 431 participants were included. Patients treated with NMBA showed less mortality (Risk ratio, 0.71 [95 % CI, 0.55 – 0.90]; number needed to treat, 1 – 7), more ventilator free days at day 28 (p = 0.020), higher PaO2 to FiO2 ratios (p = 0.004), and less barotraumas (p = 0.030). The incidence of critical illness neuromyopathy was similar (p = 0.540).


The use of NMBA in the early phase of ARDS improves outcome.

ARDS; Neuromuscular blocking agents; Meta-analysis; Review