(1) Department of Anaesthetics, Intensive Care and Pain Medicine, School of Medicine, Cardiff University, Cardiff, UK
(2) ACT Directorate, Royal Glamorgan Hospital, Cwm Taf LHB, Llantrisant, UK
* Corresponding author Email: firstname.lastname@example.org
Our aim was to review the latest available evidence about whether the use of a continuous infusion of cisatracurium, a neuromuscular blocking agent (NMBA), in patients with acute respiratory distress syndrome (ARDS) had a beneficial effect on clinical outcomes.
Materials and methods
The following databases were searched: The Cochrane Central Register of Controlled Trials (CENTRAL) (
We included three fully published randomized controlled trials containing 431 patients. The primary outcome of 28-day all-cause mortality was significantly lower in the NMBA group compared with the placebo group (RR 0.68, 95% CI = 0.51–0.92, I2 0%). NMBAs also had a statistically significant effect on ICU mortality (RR = 0.71, 95% CI = 0.55–0.90, I2 = 0%), overall mortality (RR = 0.73, 95% CI = 0.57–0.92, I2 = 0%), number of cases of new-onset barotrauma (RR = 0.43, 95% CI = 0.2–0.9, I2 = 0%) and number of ventilator-free days (MD = 1.91, 95% CI = 0.28–3.55, I2 = 0%). However, they did not show any significant effect on the duration of mechanical ventilation (RR 1.14, 95% CI = –4.07–6.35, I2 = 0%) or number of cases of new-onset critical illness neuromyopathy (RR 1.13, 95% CI = 0.76–1.67, I2 = 0%).
Our analysis showed that the early, short use of a continuous infusion of cisatracurium led to a statistically significant reduction in mortality in ARDS patients. The potential effects and drawbacks of the intervention were discussed.