Myorelaxants in ARDS patients

Sami Hraiech, Takeshi Yoshida, Djillali Annane, Abhijit Duggal, Vito Fanelli, Arnaud Gacouin, Leo M. A. Heunks, Samir Jaber, Peter D. Sottile, Laurent Papazian*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Neuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-induced lung injury (VILI) results in a lower incidence of barotrauma, improved oxygenation and a decrease in circulating proinflammatory markers. Recent randomized clinical trials did not reveal harmful muscular effects during a short course of NMBAs. The use of NMBAs should be considered during the early phase of severe ARDS for patients to facilitate lung protective ventilation or prone positioning only after optimising mechanical ventilation and sedation. The use of NMBAs should be integrated in a global strategy including the reduction of tidal volume, the rational use of PEEP, prone positioning and the use of a ventilatory mode allowing spontaneous ventilation as soon as possible. Partial neuromuscular blockade should be evaluated in future trials.
Original languageEnglish
Pages (from-to)2357-2372
Number of pages16
JournalIntensive Care Medicine
Volume46
Issue number12
Early online date2020
DOIs
Publication statusPublished - Dec 2020

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