Effect of Neuromuscular Blocking Agents on Gas Exchange in Patients Presenting With Acute Respiratory Distress Syndrome

Crit Care Med. 2004 Jan;32(1):113-9. doi: 10.1097/01.CCM.0000104114.72614.BC.

Abstract

Objective: To evaluate the effects of a 48-hr neuromuscular blocking agents (NMBA) infusion on gas exchange over a 120-hr time period in patients with acute respiratory distress syndrome.

Design: Multiple center, prospective, controlled, and randomized trial.

Setting: Four adult medical or mixed medical-surgical intensive care units.

Patients: A total of 56 patients with acute respiratory distress syndrome with a PaO2/FiO2 ratio of <150 at a positive end-expiratory pressure of > or =5 cm H2O.

Interventions: After randomization, patients received either conventional therapy without NMBA (control group) or conventional therapy plus NMBA for the next 48 hrs. The initial ventilator mode was volume-assist/control. The ventilator remained on assist-control mode throughout the initial 48-hr period in both groups. Tidal volume was 6-8 mL/kg ideal body weight.

Measurements and main results: When analyzed for the entire 120 hrs, there was a significant effect of the NMBA on the course of PaO2/FiO2 ratio (p =.021). Separate comparisons at each time point indicated that patients randomized to the NMBA group had a higher PaO2/FiO2 at 48, 96, and 120 hrs after randomization. Moreover, a decrease of positive end-expiratory pressure (p =.036) was only found in the NMBA group. Two-way repeated-measures analysis of variance exhibited a decrease in positive end-expiratory pressure over time (p =.036). Concerning short-term effects, there was no modification of PaO2/FiO2 ratio 1 hr after randomization in either group. Only one patient (from the control group) developed pneumothorax.

Conclusions: Use of NMBA during a 48-hr period in patients with acute respiratory distress syndrome is associated with a sustained improvement in oxygenation.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Blood Gas Analysis
  • Combined Modality Therapy
  • Critical Care / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Neuromuscular Blocking Agents / administration & dosage*
  • Oxygen Consumption / drug effects
  • Probability
  • Prospective Studies
  • Pulmonary Gas Exchange / drug effects*
  • Reference Values
  • Respiration, Artificial / methods*
  • Respiratory Distress Syndrome, Adult / diagnosis
  • Respiratory Distress Syndrome, Adult / mortality
  • Respiratory Distress Syndrome, Adult / therapy*
  • Risk Assessment
  • Statistics, Nonparametric
  • Treatment Outcome

Substances

  • Neuromuscular Blocking Agents