Table 1 Characteristics of included trials
Trial author or trial name | Gainnier et al. [10] | Forel et al. [9] | ACURASYS trial [11] | Guervilly et al. [27] | ROSE trial [19] |
|---|---|---|---|---|---|
Year | 2004 | 2006 | 2010 | 2017 | 2019 |
Country | France | France | France | France | USA |
NBMA vs control (patients) | 28 vs 28 | 18 vs 18 | 177 vs 162 | 13 vs 11 | 501 vs 505 |
PaO2/FIO2 ratio and PEEP for inclusion (cm H2O) | < 150 > 5 | < 200 | < 150 > 5 | 100–150 > 5 | < 150 > 8 |
Important exclusion criteria | NMBA use within 2 weeks | NMBA and steroids use within 2 weeks | Current continuous infusion of NMBA | Current continuous infusion of NMBA | Current continuous infusion of NMBA |
Ventilator management strategy | Lung protective ARDS net protocol | Lung protective ARDS net protocol | Lung protective ARDS net protocol | Lung protective ARDS net protocol | Lung protective high PEEP strategy |
Cisatracurium dose | Bolus of 50 mg, 5 μg/kg/min | Bolus 0.2 mg/kg, 5 μg/kg/min | Bolus of 15 mg, 37.5 mg/hour | Bolus of 15 mg, 37.5 mg/hour | Bolus 15 mg, 37.5 mg/hour |
Assessment for an extra dose | Train-of-four | Train-of-four | Plateau pressure > 32 | Train-of-four | No adjustment |
Sedation goal | Ramsay 6 | Ramsay 6b | Ramsay 6 | Ramsay 6 | RASS − 4, − 5 in the intervention group RASS 0 to − 1 in the control group)c |
Risk of bias | |||||
 Sequence generation | Low | low | Low | Low | Low |
 Allocation concealment | Low | Low | Low | Low | Low |
 Blinding | Higha | Higha | Low | Higha | Higha |
 Withdrawal | Low | Low | Low | Low | Low |
 Selective outcome | Low | Low | Low | Low | Low |
 Free of other bias | Low | Low | Low | Low | Low |
 Overall | High | High | Low | High | High |