Neuromuscular Blockers in Early ARDS

Posted by: admin on: October 11, 2011

Background. Neuromuscular blocking agents are occasionally used in mechanically ventilated patients with severe ventilation and oxygenation impairment when sedatives are not effective.[5] Papazian and associates sought to determine whether treatment with a neuromuscular blocker improved clinical outcomes in patients with early severe acute respiratory distress syndrome (ARDS)

Patients were randomly assigned to cisatracurium besylate or placebo for 48 hours. The primary outcome was 90-day mortality. Secondary outcomes included 28-day mortality, length of stay, organ failure-free days, rate of barotraumas, rate of ICU paresis, ventilator-free days, and Medical Research Council scores on day 28 and on discharge.

The cisatracurium group had more ventilator-free days, more organ failure-free days, and more ICU-free days compared with the control group. Groups did not differ in ICU-acquired paresis.

Conclusions. In patients with early, severe ARDS, administration of a neuromuscular blocker improved 90-day survival and increased the number of ventilator-free days without causing increasing muscular weakness.

Rationale for Selection

The only intervention shown to improve mortality in ARDS is low tidal volume ventilation. As a result, the findings in this study point to other mechanisms that may positively influence outcomes in ARDS. Future studies would be useful to determine whether neuromuscular blockers are indeed beneficial in severe ARDS and to investigate the mechanisms responsible for their effect.

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