[Systematic evaluation of neuromuscular blocking agents on prognosis of patients with moderate to severe acute respiratory distress syndrome].

Objective: To evaluate the prognostic impact of neuromuscular blocking agents (NMBA) on patients with acute respiratory distress syndrome (ARDS). Method: Online search of MEDLINE, Embase, Web of Science, CNKI, CBM and other Chinese databases for randomized controlled trials (RCTs) of NMBA in patients with ARDS from January 1994 to June 2019 was done, and literature was selected according to inclusion and exclusion criteria. The patients were divided into NMBA group and non-NMBA group according to whether NMBA was adopted or not. The prognostic indicators (ICU mortality, 28 d mortality, 90 d mortality) and NMBA-related complications (ICU acquired muscle weakness, barometric injury, pneumothorax) of the patients in the two groups were mainly analyzed. Meta-analysis of the data was performed using RevMan 5.0 software. Results: A total of 6 RCTs were included, and 1 502 patients were enrolled, including 761 in the NMBA group and 741 in the no-NMBA group. The 90-day mortality in the NMBA group and no-NMBA group were 38.8% and 42.6%, OR=0.87 (95%CI: 0.70-1.07, P=0.190); the 28-day mortality rates were 32.5% and 36.5%, OR=0.71 (95%CI: 0.45-1.11, P=0.130); ICU mortality rates were 31.8% and 43.8%, OR=0.60 (95%CI: 0.41-0.88, P=0.009). Conclusion: NMBA can reduce the ICU mortality of moderate to severe ARDS patients, but not reduce 28-day and 90-day mortality.