SynthesisPloS one2020
Neuromuscular blockers in the acute respiratory distress syndrome: A meta-analysis.
Synthesis in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 27 citations in OpenAlex.
- Bibliometric Analysis of Research Trends and Global Collaborations in Anesthesia on Neuromuscular Blockers and Antagonists (2000-2024).Healthcare (Basel, Switzerland) · 2025Article
- Successful management of pulmonary edema secondary to accidental electrocution in a young dog.BMC veterinary research · 2024Article
- Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases.Journal of clinical medicine · 2024Review
- Understanding clinical and biological heterogeneity to advance precision medicine in paediatric acute respiratory distress syndrome.The Lancet. Respiratory medicine · 2023Review
- Ulinastatin alleviates pulmonary edema by reducing pulmonary permeability and stimulating alveolar fluid clearance in a rat model of acute lung injury.Iranian journal of basic medical sciences · 2022Article
- Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis.Critical care (London, England) · 2022Article
- Neuromuscular blocking drugs in the critically ill.BJA education · 2021Review
- The Implementation of Protocol-Based Utilization of Neuromuscular Blocking Agent Using Clinical Variables in Acute Respiratory Distress Syndrome Patients.Critical care explorations · 2021Article
- Acute lung injury - from pathophysiology to treatment.Physiological research · 2020Review
- Myorelaxants in ARDS patients.Intensive care medicine · 2020Review
- Neuromuscular blocking agents in acute respiratory distress syndrome: updated systematic review and meta-analysis of randomized trials.Intensive care medicine experimental · 2020Review
- A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection.Critical care (London, England) · 2020Review
- Impact of Asynchronies in Acute Respiratory Distress Syndrome Due to Coronavirus Disease 2019.Critical care explorations · 2020Article
- Neuromuscular blockade management in the critically Ill patient.Journal of intensive care · 2020Review
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe effects of neuromuscular blocking agents (NMBAs) on adult patients with acute respiratory distress syndrome (ARDS) remain unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate its effect on mortality.
methodsWe searched the Cochrane (Central) database, Medline, Embase, the Chinese Biomedical Literature Database (SinoMed), WanFang data and ClinicalTrials from inception to June 2019, with language restriction to English and Chinese. We included published RCTs and eligible clinical trials from ClinicalTrials.gov that compared NMBAs with placebo or usual treatment in adults with ARDS. We pooled data using random-effects models. The primary outcome was mortality. The secondary outcomes were the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FIO2), total positive end expiratory pressure (PEEP), plateau pressure (Pplat), days free of ventilator at day 28, barotrauma and ICU-acquired weakness.
resultsWe included 6 RCTs (n = 1557). Compared with placebo or usual treatment, NMBAs were associated with lower 21 to 28-day mortality (RR 0.72, 95% CI 0.53-0.97, I2 = 59%). NMBAs significantly improved oxygenation (Pao2:Fio2 ratios) at 48 hours (MD 27.26 mm Hg, 95% CI 1.67, 52.84, I2 = 92%) and reduced the incidence of barotrauma (RR 0.55, 95% CI 0.35, 0.85, I2 = 0). However, NMBAs had no effect on oxygenation (Pao2:Fio2 ratios) (MD 18.41 mm Hg, 95% CI -0.33, 37.14, I2 = 72%) at 24 hours. We also found NMBAs did not affect total PEEP, plateau pressure, days free of ventilation at day 28 and ICU-acquired weakness.
conclusionsIn patients with moderate-to-severe ARDS, the administration of NMBAs could reduce 21 to 28-day mortality and barotrauma, and improve oxygenation at 48 hours, but have no significant effects on 90-day/ICU mortality, days free of ventilation at day 28 and the risk of ICU-acquired weakness. Further large-scale, high-quality RCTs are needed to confirm our findings. Registration: PROSPERO (ID: CRD 42019139656).
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