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Neuromuscular blocking agents are used variably in patients with acute respiratory distress syndrome (ARDS), usually when sedatives alone are insufficient to achieve adequate ventilation.
French researchers conducted a multicenter double-blind trial that involved 339 patients to examine whether neuromuscular blockers, administered early in the course of ARDS, conferred a mortality benefit. Patients were randomized to receive cisatracurium besylate (Nimbex) or placebo by continuous infusion for 48 hours. Open-label rapid infusion of cisatracurium was permitted in both groups if end-inspiratory plateau pressures were elevated persistently.
The adjusted hazard ratio for in-hospital death within 90 days was 0.68 in the cisatracurium group (P=0.04…