Neuromuscular blockade in patients with ARDS: a rapid practice guideline
Top Cited Papers
- 26 October 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 46 (11), 1977-1986
- https://doi.org/10.1007/s00134-020-06227-8
Abstract
The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) is to formulate an evidence-based guidance for the use of neuromuscular blocking agents (NMBA) in adults with acute respiratory distress syndrome (ARDS). The panel comprised 20 international clinical experts from 12 countries, and 2 patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines and followed a strict conflict of interest policy. We convened panelists through teleconferences and web-based discussions. Guideline experts from the guidelines in intensive care, development, and evaluation Group provided methodological support. Two content experts provided input and shared their expertise with the panel but did not participate in drafting the final recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence and grade recommendations and suggestions. We used the evidence to decision framework to generate recommendations. The panel provided input on guideline implementation and monitoring, and suggested future research priorities. The overall certainty in the evidence was low. The ICM-RPG panel issued one recommendation and two suggestions regarding the use of NMBAs in adults with ARDS. Current evidence does not support the early routine use of an NMBA infusion in adults with ARDS of any severity. It favours avoiding a continuous infusion of NMBA for patients who are ventilated using a lighter sedation strategy. However, for patients who require deep sedation to facilitate lung protective ventilation or prone positioning, and require neuromuscular blockade, an infusion of an NMBA for 48 h is a reasonable option.Keywords
This publication has 32 references indexed in Scilit:
- GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendationsJournal of Clinical Epidemiology, 2013
- Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trialsCritical Care, 2013
- GRADE guidelines: 3. Rating the quality of evidenceJournal of Clinical Epidemiology, 2011
- Neuromuscular Blockers in Early Acute Respiratory Distress SyndromeNew England Journal of Medicine, 2010
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendationsBMJ, 2008
- Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome*Critical Care Medicine, 2006
- A Prospective Randomized Comparison of Train-of-Four Monitoring and Clinical Assessment During Continuous ICU Cisatracurium ParalysisSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2004
- Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome*Critical Care Medicine, 2004
- Cost Considerations in Sedation, Analgesia, and Neuromuscular Blockade in the Intensive Care UnitSeminars in Respiratory and Critical Care Medicine, 2001
- Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study Commentary: Varied preferences reflect the reality of clinical practiceBMJ, 2001