Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome

• Published in: The New England journal of medicine Vol. 363; no. 12; pp. 1107 - 1116
• Main Authors: Papazian, Laurent, Forel, Jean-Marie, Gacouin, Arnaud, Penot-Ragon, Christine, Perrin, Gilles, Loundou, Anderson, Jaber, Samir, Arnal, Jean-Michel, Perez, Didier, Seghboyan, Jean-Marie, Constantin, Jean-Michel, Courant, Pierre, Lefrant, Jean-Yves, Guérin, Claude, Prat, Gwenaël, Morange, Sophie, Roch, Antoine
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 16.09.2010
• Subjects: Anesthesia; Atracurium - adverse effects; Atracurium - analogs & derivatives; Atracurium - therapeutic use; Biological and medical sciences; Combined Modality Therapy; Double-Blind Method; General aspects; Humans; Infusions, Intravenous; Medical sciences; Middle Aged; Mortality; Multiple Organ Failure; Neuromuscular Blocking Agents - adverse effects; Neuromuscular Blocking Agents - therapeutic use; Pneumothorax - epidemiology; Proportional Hazards Models; Respiration, Artificial; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - drug therapy; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Statistical analysis; Survival Rate; Treatment Outcome; Ventilation; Ventilator Weaning - methods; Neuromuscular blocking agent; Medicine; Early; Adult respiratory distress syndrome
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1005372

The investigators induced muscle paralysis in patients with the acute respiratory distress syndrome (ARDS) by administering a neuromuscular blocking agent, cisatracurium besylate. As compared with placebo, cisatracurium resulted in a lower adjusted 90-day mortality without more severe sequelae of neuromuscular blockade. The acute respiratory distress syndrome (ARDS) is characterized by hypoxemic respiratory failure; it affects both medical and surgical patients. 1 Despite rigorous physiological management, 2 in most studies, ARDS has been fatal in 40 to 60% of patients. 3 – 7 Neuromuscular blocking agents are used in a large but highly variable proportion of patients with ARDS. 8 – 12 Current guidelines indicate that neuromuscular blocking agents are appropriate for facilitating mechanical ventilation when sedation alone is inadequate, most notably in patients with severe gas-exchange impairments. 10 In a four-center randomized, controlled trial of gas exchange in 56 patients with ARDS, 13 infusion of a neuromuscular blocking agent . . .