What is the evidence for neuromuscular blockade in ARDS?

Intervention
Population
Conclusion

RCT: ACURASYS

Papazian et al
NEJM (2010)

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  • Cisatracurium vs. placebo for 48 hours
  • 348 patients with severe ARDS (P/F ratio <13 kPa)
  • No significant difference in 60-day mortality (conservative 25.5% vs. liberal 28.4%, p=0.30)
  • Conservative fluid group showed:
    • Improved oxygenation index
    • Increased number of ventilator-free
    • No increase in the prevalence of shock or AKI requiring RRT)
    The Bottom Line Review

RCT: ROSE

ARDSNet
NEJM (2019)

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  • Cisatracurium vs. placebo for 48 hours
  • 1006 patients with moderate-severe ARDS (P/F ratio <20 kPa)
  • APRV group demonstrated:
    • Reduced duration of mechanical ventilation by 6.04 days (p = 0.003)
    • Lower hospital mortality with a relative difference of 0.16 p = 0.03)