To retain spontaneous breathing or eliminate spontaneous breathing with neuromuscular blockers in acute respiratory distress syndrome patients

Abstract

Objective To investigate whether patients should retain spontaneous breath or eliminate breathing with neuromuscular blocking agent during ventilation treatment for patients with acute respiratory distress syndrome (ARDS). Methods A prospective single-blind randomized controlled trial was conducted. All patients with ARDS admitted to Department of Critical Care Medicine of Gejiu People's Hospital from July 1st, 2013 to December 31st, 2015 were enrolled. All cases met the criterion of Berlin definition, and patients with age lower than 15 years, in pregnancy or with end-stage disease were excluded. The subjects were randomly divided into retaining spontaneous breathing group and muscle paralysis group. The patients in retaining spontaneous breathing group were only sedated and analgesia to persist Ramsay sedation score from 2 to 4. Some patients would be transferred to muscle paralysis group who could not cooperate with ventilator or maintain the oxygenation. Spontaneous breathing of patients in muscle paralysis group was eliminated with vecuronium on the basis of sedation and analgesia. If high dose of vasopressor is still difficult to maintain blood pressure in muscle paralysis group, the patients would be transferred to the retaining spontaneous breathing group. The parameters of mechanical ventilation, indexes of arterial blood gas samples analysis and prognostic indexes were collected prospectively from the first day to the fifth day after mechanical ventilation. Results Totally 50 ARDS patients were enrolled in this study, 9 patients were excluded (2 patients not intubated, 1 patient with severe traumatic brain injury, 1 patient with confirmed diagnosis of acute myocardial infarction, 5 patients discharged by themselves owing to the short of money). Finally, there were 17 patients in the retaining spontaneous breathing group and 24 in the muscle paralysis group (6 patients were transferred from the retaining spontaneous breathing group). Patients in muscle paralysis group were significantly younger than those in the retaining spontaneous breathing group (age: 35±16 vs. 50±16, P 0.05). Conclusions A neuromuscular blocking agent administrated to the ARDS patients on mechanical ventilation was safe, which will not increase mortality, ventilator days and ICU days. Especially, in patients with severe ARDS, administration of a neuromuscular blocking agent improved the oxygenation. Key words: Acute respiratory distress syndrome; Spontaneous breathing; Muscle paralysis; Mortality