Use of neuromuscular blocking agents in acute respiratory distress syndrome

LETTER TO THE EDITOR Potential Hazards of Neuromuscular Blocking Agents in the Treatment of Acute Respiratory Distress Syndrome. Comment on: “Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome”

While the mechanisms responsible for the adjusted mortality benefit reported by Papazian et al. remain speculative, it is highly likely that lower transpulmonary pressures (TPPs) in the cisatracurium group were responsible for some portion of the reported benefit. This is suggested by the three-fold incidence of pneumothorax in the placebo group compared to the cisatracurium group despite no di...

Benefits of Neuromuscular Blocking Agents in Acute Respiratory Distress Syndrome Patients: What Is the Evidence?

NMBAs are commonly used in ARDS (25–55% of patients), but the benefits and the risks of using these agents are controversial. Recent data suggest that a continuous infusion of cisatracurium during the first 48 h of ARDS, particularly for patients with a PaO2/FiO2 ratio less than 120, can decrease 90-day inhospital mortality. NMBAs do not appear to be an independent risk factor for ICU-acquired ...

Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION Randomized trials investigating neuromuscular blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness. METHODS We conducted a systematic review and meta-analysis. We searched the Cochrane (Central) databas...

Neuromuscular blockers in early acute respiratory distress syndrome.

BACKGROUND In patients undergoing mechanical ventilation for the acute respiratory distress syndrome (ARDS), neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but may also cause muscle weakness. We evaluated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early, severe ARDS. METHODS In this multicent...

tracheal intubation without the use of neuromuscular blocking agents