Neuromuscular blocking agents for acute respiratory distress syndrome

J Crit Care. 2019 Feb;49:179-184. doi: 10.1016/j.jcrc.2018.10.019. Epub 2018 Oct 28.

Abstract

Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate thereby resulting in respiratory failure. Treatment of ARDS is often a multimodal approach using both nonpharmacologic and pharmacologic treatment strategies in addition to trying to reverse the underlying cause of ARDS. Neuromuscular blocking agents (NMBAs) have been prescribed to patients with ARDS as they are thought to decrease inflammation, oxygen consumption, and cardiac output and help facilitate ventilator synchrony. NMBAs have only been evaluated in patients with early, severe ARDS in three multicenter, randomized, controlled trials (n = 432), but have resulted in decreased inflammation and improved oxygenation, ventilator-free days, and mortality. Despite reports of NMBAs being associated with adverse effects like postparalytic quadriparesis, myopathy, and prolonged recovery, these effects have not been seen in patients receiving short courses of NMBAs for ARDS. A large multicenter, prospective, randomized, placebo-controlled trial is ongoing to confirm benefit of NMBAs in early, severe ARDS when adjusting for limitations of the previous studies. The current available literature suggests that 48 h of NMBA therapy in patients with early, severe ARDS improves mortality, without resulting in additional patient harm.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adult
  • Critical Care
  • Critical Illness
  • Drug Administration Schedule
  • Epidemiologic Methods
  • Female
  • Humans
  • Male
  • Neuromuscular Blocking Agents / adverse effects
  • Neuromuscular Blocking Agents / pharmacology
  • Neuromuscular Blocking Agents / therapeutic use*
  • Oxygen / blood
  • Partial Pressure
  • Prospective Studies
  • Respiration, Artificial / statistics & numerical data
  • Respiratory Distress Syndrome / drug therapy*
  • Respiratory Distress Syndrome / mortality
  • Risk Factors
  • Treatment Outcome

Substances

  • Neuromuscular Blocking Agents
  • Oxygen