Summary of the Evidence-Based Data and Limitations

Two recent meta-analyses based on these three trials [17, 18] have investigated the role of NMBA use for ARDS. The meta-analysis conducted by Alhazzani and colleagues [17] concluded that the use of cisatracurium besylate for a short period in the early phase of ARDS consistently reduced the risk of death at 28 days, reduced the times to ICU discharge and hospital discharge (number needed to treat = 9), reduced the risk of barotrauma, increased the number of ventilator-free days and did not affect the risk of ICU-acquired weakness. The study conducted by Neto and colleagues [18] strongly confirmed all of these results and stated that the use of NMBAs was associated with decreases in the PEEP and plateau pressure over time in the group of paralysed patients, which reflected improved ventilation.

The main criticism that could be levied is that these two meta-analyses were based on only three randomized controlled trials that were conducted by the same group, which may have introduced bias into the conclusions. However, as noted by Neto and colleagues, the main study on which these meta-analyses were based included 20 different ICUs, which reduced the risk of bias.