NMBAs compared to placebo for ARDS
| Patient or population: adults with ARDS Settings: intensive care Intervention: NMBAs, cisatracurium infusion in all studies Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of evidence (GRADE) | Comments | |
| Control risk | Intervention risk | |||||
| Placebo | NMBAs | |||||
| Mortality (ICU) | 447 per 1000 | 313 per 1000 (246 to 398) | RR 0.70 (0.55 to 0.89) | 431 (three studies) | +++- MODERATE Due to serious risk of bias and serious indirectness | All trials studied a 48 hours infusion of cisatracurium besylate |
| Mortality (28 day) | 389 per 1000 | 257 per 1000 (195 to 339) | RR 0.66 (0.50 to 0.87) | 431 (three studies) | +++- MODERATE Due to serious risk of bias and serious indirectness | See above |
| Mortality (hospital) | 471 per 1000 | 339 per 1000 (273 to 429) | RR 0.72 (0.58 to 0.91) | 431 (three studies) | +++- MODERATE Due to serious risk of bias and serious indirectness | See above truncated at 90 days |
| Adverse events: ICU acquired weakness | 298 per 1000 | 322 per 1000 (247 to 420) | RR 1.08 (0.83 to 1.41) | 431 (three studies) | +--- VERY LOW Due to very serious risk of bias, serious inconsistency and serious indirectness | Lack of robust screening for weakness in first two RCTs. Third RCT only assessed weakness until ICU discharge. Screening methods differed greatly between RCT |
ARDS, acute respiratory distress syndrome; ICU, intensive care unit; NMBA, neuromuscular blocking agents; RCT, randomised controlled trial.