The Role of Neuromuscular Blockers in Early ARDS

Abstract

The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) remains controversial. However, NMBAs are used in 25% to 45% of ALI/ARDS patients for a mean period of 1±2 days, especially in severe ARDS. Hypoxemia and facilitation of mechanical ventilation are the main indications of NMBAs. Three randomized, controlled trials showed that the systematic early use of NMBAs is associated with a sustained improvement in oxygenation in ARDS patients. The most recent trial reported a decrease in 90-day in-hospital mortality rate when severe ARDS patients received a short course of muscle relaxants. The use of NMBAs in the early phase of ARDS could reinforce the beneficial effects of a lung-protective ventilation strategy. However, the role of prolonged NMBA administration in intensive care unit–acquired paresis in ARDS patients remains largely questioned. This review analyzes the recent findings in the literature concerning the effects of NMBAs on gas exchange and patient outcomes, and their potential adverse effects in ARDS.