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Table 1 Characteristics of included studies

From: Neuromuscular blocking agents in acute respiratory distress syndrome: updated systematic review and meta-analysis of randomized trials

Study Population Agent/Dose NMBA PRN PEEP Prone ventilation Sedation target Sedative Ventilation Protocol Steroids
Gainnier 2004 [18] ARDS
PaO2/FiO2 < 150
PEEP ≥ 5
Eligible < 36 h
Exclude prior NMBA
cisatracurium bolus of 50mg then infusion at 5 mcg/kg/min NR 11.1±2.8 14.3% Deep
Ramsay score 6
Midazolam
Sufentanil
Yes 7.1%
Placebo (0.9% NS) 48 h: 7.1% 10.9±2.4 14.3% Deep
Ramsay score 6
Midazolam
Sufentanil
Yes 14.3%
Forel 2006 [19] ARDS
Intubated < 48 h
PaO2/FiO2 < 200
Exclude recent steroids or NMBA
cisatracurium bolus of 0.2 mg/kg then infusion at 5 mcg/kg/min
Titrated (increase of 20% if TOF >1) to obtain no response on TOF
48 h: NR
ICU stay: 5.6%
9±2.3 - Deep
Ramsay score 6
Midazolam
Sufentanil
Yes
Same protocol for the first 5 days
5.5%
Placebo (0.9%NS) 48 h: 0%
ICU stay: 5.6%
9.9±2.9 - Deep
Ramsay score 6
Midazolam
Sufentanil
Yes 0%
Papazian 2010 [8] ARDS
PaO2/FiO2 < 150
Eligible < 48 h
Exclude prior NMBA
cisatracurium 15 mg bolus then infusion of 37.5 mg/h for 48h 48 h: 10%
ICU stay: 50%
9.2±3.2 28% Deep
Ramsay score 6
Sufentanil
Midazolam
Ketamine
Propofol
Yes 39.5%
Placebo 48 h: 22%
ICU stay: 56%
9.2±3.5 29% Deep
Ramsay score 6
Sufentanil
Midazolam
Ketamine
Propofol
Yes 45.1%
Lyu 2014 [20] Severe sepsis and moderate to severe ARDS by Berlin criteria Vecuronium - - - Deep - - -
No placebo - - - Deep - - -
Rao 2016 [22] ARDS by Berlin criteria Vecuronium - - - - - - -
No placebo - - - - - - -
Guervilly 2016 [21] ARDS;
PaO2/FiO2 < 150 with PEEP at least 5 within 48 hours of ARDS onset
cisatracurium 15 mg bolus then infusion of 37.5 mg/h for 48h - 10 (9; 12) - Deep
Ramsay score 6
Sufentanil
Midazolam Ketamine
ARDSnet protocol -
No infusion, but severe ARDS received PRN NMBA - 11(10;11.5) - Deep
Ramsay score 6
Sufentanil
Midazolam
Ketamine
ARDSnet protocol -
ROSE 2019 [11] ARDS with PaO2/FiO2 <150 + PEEP>8cmH2O cisatracurium 15 mg bolus then infusion of 37.5 mg/h for 48h 48 h: 0.9%
After 48h: 16.0%
12.6±3.6 16.8% Deep
RASS -5 or Ramsay 5-6
- ARDSNet Day 7: 17.0%
Usual care 48h:17.0%
After 48h: 7.9%
12.5±3.6 14.9% Light
RASS: 0 to -1, Riker: 3 to 4, or Ramsay: 2-3
- ARDSNet Day 7: 16.4%
  1. ARDS acute respiratory distress syndrome, ARMA the Acute Respiratory Distress Syndrome Network, ICU intensive care unit, NMBA neuromuscular blocking agents, NS normal saline, PaO2/FiO2 ratio of partial arterial pressure of oxygen to fraction of inspired oxygen, PEEP positive end expiratory pressure, RASS Richmond Agitation-Sedation Scale, TOF train of four