Table 1.
Patient characteristics and outcomes in the seven randomized controlled trials and the COVID-19 ARDS studies concerning NMBA use in ARDS.
| Patients | Primary End Point | Time of Inclusion | ΝΜΒA | Dose | Monitoring | Duration | Sedation | PEEPtot | VT | Pplat | PaO2/FiO2 | Proning | Steroids | Barotrauma | VAP | ICUAW | VFD 28/60 | Mortality | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Gainnier [55] | 56 | Effect on oxygenation after 120 h | Within 36 h meeting inclusion criteria | cis | 50 mg bolus | TOF every 8 h | 48 | midazolam sufentanil | 12.3 ± 3 | 7.1 ± 1.1 | 27.1 | 130 ± 34 | 14.3% | 7.1% | 0 | 46% | 0 | D28: 3.7 ± 37.2 | D28: 35.7% |
| 2004 | PaO2/FiO2 < 150 mmHg | 5 μg/kg/min | Ramsey 6 | D60: 19 ± 320.3 | D60: 46.4% | ||||||||||||||
| ICU: 46.4% | |||||||||||||||||||
| actual: 1324 ± 197 | 11.4 ± 2.5 | 7.4 ± 31.9 | 26.1 ± 4 | 119 ± 31 | 14.3% | 14.3% | 1 | 57% | 0 | D28: 1.7 ± 35.3 (NS) | D28: 60.7 (p = 0.061) | ||||||||
| D60: 9.8 ± 16.9 (0.071) | D60: 64.3% (p = 0.18) | ||||||||||||||||||
| ICU: 71.4% (p = 0.057) | |||||||||||||||||||
| Forel [42] | 5.5% | ||||||||||||||||||
| 2006 | 36 | Effect on pulmonary and systemic proinflammatory cytokines | 48 h of ARDS onset | cis | bolus 0.2 mg/kg | TOF every 8 h | 48 h | 13.2 ± 2.7 | 6.5 ± 0.7 | 27.5 ± 4.4 | 0 | 0 | 1 | D28: 6 ± 8.6 | ICU: 27.8% | ||||
| PaO2/FiO2 < 200 mmHg | 5 μg/kg/min | 11 ± 2.7 (p < 0.05) | 7 ± 30.7 | 24.8 ± 35.7 | 0 | 0 | 1 | D28: 5.4 ± 6.4 (ns) | ICU: 55.6% (NS) | ||||||||||
| Guervilli [34] | 30 | Effect on respiratory mechanics | 48 h of ARDS onset | cis | bolus 15 mg | TOF | 48 h | midazolam/sufentanil | 11 (10–11.5) | 6.2 (5.9–6.8 | 23 (19–26) | 158 (131–185) | D28: 7 (0–20) | ICU: 38% | |||||
| 2017 | PaO2/FiO2 100–150 mmHg | 37.5 mg/h | Ramsey 6 | 150 (121–187) | D28: 8(0–18) | ICU: 27% (p = 0.6) | |||||||||||||
| Rao [56] | 41 | vecuronium | actual: 1595 mg (1221–1830) | 7.84 ± 2.94 | 4.2% | D28: 17.9 ± 2.77.4 | D28: 4.2% | ||||||||||||
| 2016 | ARDS pts | 90: 4.2% | |||||||||||||||||
| 0 | D28: 17.1 ± 8.2 | D28: 11.8% | |||||||||||||||||
| 5.88 ± 1.96 | 90: 17.6% | ||||||||||||||||||
| Lyu [27] 2014 |
96 | vecuronium | 0.05 mg/kg/h | 24–48 h | 140.95 ± 26.97 | D21: 16.7% | |||||||||||||
| PaO2/FiO2 < 200 mmHg (24) | D21: 25% (p = 0.035) | ||||||||||||||||||
| PaO2/FiO2 < 100 mmHg (24) | 144.33 ± 24.09 | D21: 20.8% | |||||||||||||||||
| D21: 50% (0.477) | |||||||||||||||||||
| Papazian [21] | 340 | 48 h of ARDS onset | cis | bolus 15 mg | Ramsay 6 | midazolame | 9.2 ± 3.2 | 6.55 ± 1.12 | 25 ± 5.1 | 106 ± 36 | 28% | 16% | 4% | 28D: 70.8% | 28D: 10.6 ± 9.7 | 28D: 23.7% | |||
| 2010 | PaO2/FiO2 < 150 mmHg | 90-day mortality | actual inclusion time: 16 h | 37.5 mg/h | sufentanil | icu discharge: 64.3% | 90D: 53.1 ± 35.8 | ICU: 29.4% | |||||||||||
| ketamin | In hospital: 32.2% | ||||||||||||||||||
| propofole | |||||||||||||||||||
| 9.2 ± 3.5 | 6.48 ± 0.92 | 24.4 ± 4.7 | 115 ± 41 | 29% | 23%(p = 0.1) | 11.7% (p = 0.01) | 28D:67.5% (p = 0.64) | 28D: 8.5 ± 9.4 (p = 0.04) | 28D: 33.3% (p = 0.05) | ||||||||||
| icu discharge: 68.5% (p = 0.51) | 90D: 44.6 ± 37.5 (p = 0.03) | ICU: 38.9% (p = 0.06) | |||||||||||||||||
| In hospital: 32.2% (p = 0.08) | |||||||||||||||||||
| ROSE [20] | 1006 | 90-day mortality | 48 h of ARDS onset | cis | bolus: 15 mg | Ramsey 5–6 | 48 h | 12.6 ± 3.6 | 6.3 ± 0.9 | 25.5 ± 6.0 | 98.7 ± 27.9 | 16.8% | 17% | 4% | D7: 41% | D28: 9.6 ± 10.4 | D90: 42.5% | ||
| 2019 | PaO2/FiO2 < 150 mmHg | actual randomization time: 8 h | 37.5 mg continuous infusion | RASS −5 | D28:46.8% | D28: 36.7% | |||||||||||||
| Ramsey 2–3 | 12.5 ± 3.5 | 6.3 ± 0.9 | 25.7 ± 6.1 | 99.5 ± 27.9 | 14.9% | 16.4% | 6.3% | D7: 31.3% | D28:9.9 ± 10.9 | D90: 42.8% | |||||||||
| RASS 0 to −1 | D28:27.5% | D28: 37% | |||||||||||||||||
| Courcelle [52] | 407 | NMBA use | 5 days (IQR 2–10) | <48 h: 12 (10–14) | 6.1 (5.8–6.6) | 23 (20–26) | 126 (88–162) | 65% | D28: 0 (0–16) | ICU: 38% | |||||||||
| 2020 | PaO2/FiO2 < 150 mmHg | 28-day outcomes | Propensity cohort 78% | ||||||||||||||||
| COVID-19 ARDS | |||||||||||||||||||
| >48 h: 11 (10–13) | 6.1 (5.8–6.6) | 24 (21–26) | 120 (87–157) | 90% (p < 0.001) | D28: 0 (0–10) | ICU: 41% (p = 0.54) | |||||||||||||
| propensity cohort: 80% (p = 0.86) | |||||||||||||||||||
| Lee [53] | 129 | ICU mortality | 5 days (4–9) | survivors: 10 (9–12) | 7 (6.2–7.9) | 123 (87–197) | 16% | 92% | 53% (superinfection rate) | 8.2 ± 9.7 | ICU 37% | ||||||||
| 2022 | COVID-19 ARDS | survivors: 20% | 91% | mild ARDS: 20% | |||||||||||||||
| non-survivors: 10% | 94% | moderate ARDS: 40% | |||||||||||||||||
| non-survivors: 10 (10–12) | 6.8 (6.2–8.3) | 109 (85–134) | severe ARDS: 43% | ||||||||||||||||
| Li Bassi [62] | |||||||||||||||||||
| 2022 | 1953 | 90-day mortality | No NMBA: 12 ± 3 | 7.1 ± 1.4 | 25.4 ± 5.7 | 98.1 ± 31.1 | 8.6% | 21.3% | 12.4% | ||||||||||
| COVID-19 ARDS (moderate and severe) | No NMBA(PS): 11.9 ± 2.73.1 | 7.4 ± 1.6 | 25 ± 2.75.9 | 86 ± 30.7 | 10.5% | 22.9% | 9.6% | ||||||||||||
| 242 with early NMBA | 48 h: 74.4% | NMBA: 12.8 ± 3.3 | 6.9 ± 1.4 | 26.1 ± 2.75.1 | 88.5 ± 29.3 | 21.5% | 19.8% | 9.6% | |||||||||||
| 72 h: 25.6% | NMBA (PS): 12.8 (3.3) | 6.8 ± 1.4 | 26.2 ± 2.75 | 88.6 ± 29.7 | 21.9% | 19% | 10.4% | ||||||||||||
| Nunez-Seisderos [54] | 70 survivors with COVID-19 ARDS | ICUAW | cis | cumulative dose: 739 mg (283–1425) | 5 days (2–8) | 81 (64–97.75) | 91.4% | 100% | 65.7% | IMV DUR: 13 (7–22.5) | |||||||||
| 2022 | |||||||||||||||||||
ARDS: Acute Respiratory Distress Syndrome; ICU: Intensive Care Unit; ICUAW: Intensive Care Unit-Acquired Weakness; IMV DUR: Invasive Mechanical Ventilation Duration; NMBAs: Neuromuscular Blocking Agents; PEEP: Positive-End Expiratory Pressure; TOF: Train of Four; VFD: Ventilator-Free Days.