title: Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome.
abstract: OBJECTIVE
  To evaluate the effects of neuromuscular blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy.
  
  
  METHODS
  Multiple-center, prospective, controlled, and randomized trial.
  
  
  METHODS
  One medical and two medical-surgical intensive care units.
  
  
  METHODS
  A total of 36 patients with acute respiratory distress syndrome (Pao2/Fio2 ratio of < or =200 at a positive end-expiratory pressure of > or =5 cm H2O) were included within 48 hrs of acute respiratory distress syndrome onset.
  
  
  METHODS
  Patients were randomized to receive conventional therapy plus placebo (n = 18) or conventional therapy plus NMBAs (n = 18) for 48 hrs. Both groups were ventilated with a lung-protective strategy (tidal volume between 4 and 8 mL/kg ideal body weight, plateau pressure of < or =30 cm H2O).
  
  
  RESULTS
  Bronchoalveolar lavages and blood samples were performed, before randomization and at 48 hrs, to determine the concentrations of tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, and IL-8. Pao2/Fio2 ratio was evaluated before randomization and at 24, 48, 72, 96, and 120 hrs. A decrease over time in IL-8 concentrations (p = .034) was observed in the pulmonary compartment of the NMBA group. At 48 hrs after randomization, pulmonary concentrations of IL-1beta (p = .005), IL-6 (p = .038), and IL-8 (p = .017) were lower in the NMBA group as compared with the control group. A decrease over time in IL-6 (p = .05) and IL-8 (p = .003) serum concentrations was observed in the NMBA group. At 48 hrs after randomization, serum concentrations of IL-1beta (p = .037) and IL-6 (p = .041) were lower in the NMBA group as compared with the control group. A sustained improvement in Pao2/Fio2 ratio was observed and was reinforced in the NMBA group (p < .001).
  
  
  CONCLUSIONS
  Early use of NMBAs decrease the proinflammatory response associated with acute respiratory distress syndrome and mechanical ventilation.
authors.affiliation: Réanimation Médicale, Assistance Publique Hôpitaux de Marseille, Hôpital Sainte Marguerite, Marseille, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Valérie
authors.initials: V
authors.lastname: Marin
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Didier
authors.initials: D
authors.lastname: Demory
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Blache
authors.forename: Gilles
authors.initials: G
authors.lastname: Perrin
authors.forename: Marc
authors.initials: M
authors.lastname: Gainnier
authors.forename: Pierre
authors.initials: P
authors.lastname: Bongrand
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D016207:Cytokines / Q000097:blood / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology / Q000627:therapeutic use*; D010100:Oxygen / Q000378:metabolism; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*
chemical_list: D016207:Cytokines; D009466:Neuromuscular Blocking Agents; D010100:Oxygen