Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome.
OBJECTIVE
To evaluate the effects of a 48-hr neuromuscular blocking agents (NMBA) infusion on gas exchange over a 120-hr time period in patients with acute respiratory distress syndrome.


METHODS
Multiple center, prospective, controlled, and randomized trial.


METHODS
Four adult medical or mixed medical-surgical intensive care units.


METHODS
A total of 56 patients with acute respiratory distress syndrome with a PaO2/FiO2 ratio of <150 at a positive end-expiratory pressure of > or =5 cm H2O.


METHODS
After randomization, patients received either conventional therapy without NMBA (control group) or conventional therapy plus NMBA for the next 48 hrs. The initial ventilator mode was volume-assist/control. The ventilator remained on assist-control mode throughout the initial 48-hr period in both groups. Tidal volume was 6-8 mL/kg ideal body weight.


RESULTS
When analyzed for the entire 120 hrs, there was a significant effect of the NMBA on the course of PaO2/FiO2 ratio (p =.021). Separate comparisons at each time point indicated that patients randomized to the NMBA group had a higher PaO2/FiO2 at 48, 96, and 120 hrs after randomization. Moreover, a decrease of positive end-expiratory pressure (p =.036) was only found in the NMBA group. Two-way repeated-measures analysis of variance exhibited a decrease in positive end-expiratory pressure over time (p =.036). Concerning short-term effects, there was no modification of PaO2/FiO2 ratio 1 hr after randomization in either group. Only one patient (from the control group) developed pneumothorax.


CONCLUSIONS
Use of NMBA during a 48-hr period in patients with acute respiratory distress syndrome is associated with a sustained improvement in oxygenation.
Gainnier
Marc
M
Service de Réanimation Médicale, Hôpitaux Sud, Marseille, France.
Roch
Antoine
A
Forel
Jean-Marie
JM
Thirion
Xavier
X
Arnal
Jean-Michel
JM
Donati
Stéphane
S
Papazian
Laurent
L
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D010101:Oxygen Consumption / Q000187:drug effects; D011336:Probability; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D012016:Reference Values; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D009466:Neuromuscular Blocking Agents