No Benefit to Early Neuromuscular Blockade in Moderate-to-Severe ARDS

However, this strategy might be considered for selected patients with acute respiratory distress syndrome and ventilator dyssynchrony.

Ten years ago, a large randomized trial demonstrated lower mortality when patients with severe acute respiratory distress syndrome (ARDS) were treated with neuromuscular blockade (NMB; NEJM JW Hosp Med Oct 2010 and N Engl J Med 2010; 363:1107). Concerns about the deep sedation required for NMB, as well as the neuromuscular weakness associated with its use, led investigators to reexamine this benefit.

More than 1000 patients with moderate-to-severe ARDS (partial pressure of oxygen: fraction of inspired oxygen [PaO₂:FIO₂], <150) were randomized to 48 hours of either cisatracurium with deep sedation or light sedation without NMB. More than half of patients had pneumonia; prone positioning was used rarely. The trial included a high positive end-…

Reviewing Author

Patricia Kritek, MD

Disclosures

Editorial BoardsATS Scholar

Patricia Kritek, MD

Disclosures

Editorial BoardsATS Scholar

No Benefit to Early Neuromuscular Blockade in Moderate-to-Severe ARDS

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Reviewing Author