Neuromuscular Blocking Agents and Neuromuscular Dysfunction Acquired in Critical Illness: A Systematic Review and Meta-Analysis

David R. Price, Mark E. Mikkelsen, Craig A. Umscheid, Ehrin J. Armstrong

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Objective: The relationship between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness remains unclear. We examined the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, and critical illness myopathy. Data Sources: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and bibliographies of included studies were searched from database inception until September 24, 2015. Study Selection: Randomized controlled trials and prospective observational studies examining the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, or critical illness myopathy. Data Extraction: One author screened titles/abstracts. Two authors independently reviewed full text and extracted data from included studies. Meta-analysis was performed using the DerSimonian-Laird random effects model (OpenMetaAnalyst 10.10 for OS.X). We assessed reporting bias with funnel plots and heterogeneity with the I2 statistic. Data Synthesis: Of 2,170 titles/abstracts screened, 99 full texts were selected for review, yielding one randomized controlled trial and 18 prospective observational studies, for a total of 2,254 patients. The randomized controlled trial did not show an association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness (odds ratio, 1.21; 95% CI, 0.67-2.19), but pooled data from all included studies suggested a modest association (odds ratio, 1.25; 95% CI, 1.06-1.48; I2 = 16%). Funnel plots suggested reporting bias, and sensitivity analyses showed a disproportionate contribution from critical illness polyneuropathy/critical illness myopathy and severe sepsis/septic shock studies. Conclusions: This meta-analysis suggests a modest association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness; limitations include studies with a high risk of bias and a disproportionate contribution from studies examining patients for critical illness polyneuropathy/critical illness myopathy and those with severe sepsis/septic shock.

Original languageEnglish (US)
Pages (from-to)2070-2078
Number of pages9
JournalCritical Care Medicine
Volume44
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

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Neuromuscular Blocking Agents
Critical Illness
Meta-Analysis
Polyneuropathies
Muscular Diseases
Randomized Controlled Trials
Septic Shock
Observational Studies
Sepsis
Odds Ratio
Prospective Studies
Information Storage and Retrieval
Bibliography
PubMed
Nursing
Databases
Health

Keywords

  • acquired polyneuropathies
  • agents neuromuscular blocking
  • critical illness polyneuropathy
  • neuromuscular blockers
  • nondepolarizing muscle relaxants
  • polyneuropathy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Neuromuscular Blocking Agents and Neuromuscular Dysfunction Acquired in Critical Illness : A Systematic Review and Meta-Analysis. / Price, David R.; Mikkelsen, Mark E.; Umscheid, Craig A.; Armstrong, Ehrin J.

In: Critical Care Medicine, Vol. 44, No. 11, 01.11.2016, p. 2070-2078.

Research output: Contribution to journalReview article

Price, David R. ; Mikkelsen, Mark E. ; Umscheid, Craig A. ; Armstrong, Ehrin J. / Neuromuscular Blocking Agents and Neuromuscular Dysfunction Acquired in Critical Illness : A Systematic Review and Meta-Analysis. In: Critical Care Medicine. 2016 ; Vol. 44, No. 11. pp. 2070-2078.
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abstract = "Objective: The relationship between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness remains unclear. We examined the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, and critical illness myopathy. Data Sources: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and bibliographies of included studies were searched from database inception until September 24, 2015. Study Selection: Randomized controlled trials and prospective observational studies examining the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, or critical illness myopathy. Data Extraction: One author screened titles/abstracts. Two authors independently reviewed full text and extracted data from included studies. Meta-analysis was performed using the DerSimonian-Laird random effects model (OpenMetaAnalyst 10.10 for OS.X). We assessed reporting bias with funnel plots and heterogeneity with the I2 statistic. Data Synthesis: Of 2,170 titles/abstracts screened, 99 full texts were selected for review, yielding one randomized controlled trial and 18 prospective observational studies, for a total of 2,254 patients. The randomized controlled trial did not show an association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness (odds ratio, 1.21; 95{\%} CI, 0.67-2.19), but pooled data from all included studies suggested a modest association (odds ratio, 1.25; 95{\%} CI, 1.06-1.48; I2 = 16{\%}). Funnel plots suggested reporting bias, and sensitivity analyses showed a disproportionate contribution from critical illness polyneuropathy/critical illness myopathy and severe sepsis/septic shock studies. Conclusions: This meta-analysis suggests a modest association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness; limitations include studies with a high risk of bias and a disproportionate contribution from studies examining patients for critical illness polyneuropathy/critical illness myopathy and those with severe sepsis/septic shock.",
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AU - Armstrong, Ehrin J.

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AB - Objective: The relationship between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness remains unclear. We examined the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, and critical illness myopathy. Data Sources: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and bibliographies of included studies were searched from database inception until September 24, 2015. Study Selection: Randomized controlled trials and prospective observational studies examining the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, or critical illness myopathy. Data Extraction: One author screened titles/abstracts. Two authors independently reviewed full text and extracted data from included studies. Meta-analysis was performed using the DerSimonian-Laird random effects model (OpenMetaAnalyst 10.10 for OS.X). We assessed reporting bias with funnel plots and heterogeneity with the I2 statistic. Data Synthesis: Of 2,170 titles/abstracts screened, 99 full texts were selected for review, yielding one randomized controlled trial and 18 prospective observational studies, for a total of 2,254 patients. The randomized controlled trial did not show an association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness (odds ratio, 1.21; 95% CI, 0.67-2.19), but pooled data from all included studies suggested a modest association (odds ratio, 1.25; 95% CI, 1.06-1.48; I2 = 16%). Funnel plots suggested reporting bias, and sensitivity analyses showed a disproportionate contribution from critical illness polyneuropathy/critical illness myopathy and severe sepsis/septic shock studies. Conclusions: This meta-analysis suggests a modest association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness; limitations include studies with a high risk of bias and a disproportionate contribution from studies examining patients for critical illness polyneuropathy/critical illness myopathy and those with severe sepsis/septic shock.

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KW - neuromuscular blockers

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