Paralytics in critical care: not always the bad guy.
OBJECTIVE
The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury remains controversial, although frequent. This review analyzes the effects of NMBAs on thoracopulmonary mechanics, gas exchange, patient outcome and their potential adverse effects.


RESULTS
NMBAs are used in 25-45% of acute lung injury/ARDS patients for a mean period of 12 days, especially in severe ARDS. Hypoxemia and facilitation of mechanical ventilation are the main indications of NMBAs. Two randomized controlled trials showed that the systematic early use of NMBAs is associated with a sustained improvement in oxygenation in ARDS patients. The most recent suggests a beneficial effect on proinflammatory response associated with ARDS and mechanical ventilation.


CONCLUSIONS
The use of NMBAs in acute lung injury/ARDS patients is not marginal. Recent studies suggest a beneficial effect of early use of NMBAs on oxygenation and inflammation. The role of NMBAs in the occurrence of ICU-acquired neuromyopathies and lung atelectasis in ARDS patients remains largely questioned. The use of NMBAs in the early phase of ARDS could reinforce the beneficial effects of a lung-protective ventilation. In this context, the effect of NMBAs on the outcome of ARDS patients must be evaluated.
Forel
Jean-Marie
JM
Réanimation Médicale, Hôpitaux de Marseille, URMITE CNRS-UMR 6236, Université de la Méditerranée, Marseille, France.
Roch
Antoine
A
Papazian
Laurent
L
D003422:Critical Care; D006801:Humans; D007362:Intensive Care Units; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012128:Respiratory Distress Syndrome / Q000188:drug therapy; D015656:Respiratory Mechanics / Q000187:drug effects
D009466:Neuromuscular Blocking Agents