Neuromuscular Blockade Applicability in Early Acute Respiratory Distress Syndrome

Papazianet al.1 reported in 2010 that use of neuromuscular blocking agents within 48  h of development of acute respiratory distress syndrome (ARDS) had a positive effect on survival in patients with severe disease (Pao2/Fio2 less than 120 mmHg) compared with management with deep sedation alone. Supporting this survival benefit, a retrospective study by Steingrubet al.2 reported lower in-hospital mortality when mechanically ventilated patients with severe sepsis and a respiratory source of infection received neuromuscular blocking agents within the first two hospital days (treated: 31.9%, untreated: 39.3% in-hospital mortality;P< 0.001). Possible mechanisms by which this benefit might occur include decreasing oxygen consumption and improving oxygenation, decreasing the systemic inflammatory response associated with ARDS, and improving patient –ventilator synchrony. The general use of neuromuscular blocking agents in early ARDS, however, is not without consequence. Risks associated with this intervention include prolonged mechanical ventilation owing to excessive sedation, prolonged paralysis after discontinuation of neuromuscular block ing agents, development of critical illness myopathy and polyneuropathy, development of corneal abrasions and ulcerations, and risk of apnea with unrecognized ventilator disconnections.3 A decade later, The National Heart, Lung, and Blood Institute (Bethesda, Maryland) Prevention and Early Treatment of Acute Lung Injury Clinical Trials N...
Source: Anesthesiology - Category: Anesthesiology Source Type: research