The use of paralytics in patients with acute respiratory distress syndrome

Abstract

Interest in the role of neuromuscular blocking agents (NMBAs) in the treatment of acute respiratory distress syndrome (ARDS) has been renewed since a recent randomized clinical trial showed a reduction in mortality associated with the use of NMBAs. However, the role of paralytics in a protective mechanical ventilation strategy should be detailed. This review summarizes data in the literature concerning the clinical effects of NMBAs on the outcome of patients with ARDS, in an attempt to explain some pathophysiologic hypotheses concerning their action and to integrate them into the overall management strategy for the mechanical ventilation of ARDS patients.

Keywords: Acute respiratory distress syndrome; ICU-acquired weakness; Mechanical ventilation; Neuromuscular blocking agents; Protective ventilation; Spontaneous ventilation; Transpulmonary pressure.