title: The role of neuromuscular blockers in ARDS:  benefits and risks.
abstract: OBJECTIVE
  Neuromuscular blocking agents (NMBAs) are part of the pharmaceutical arsenal employed to treat acute respiratory distress syndrome (ARDS). However, their use remains controversial because the potential benefits of these agents are counterbalanced by possible adverse effects. This review summarizes advantages and risks of NMBAs based on the most recent literature.
  
  
  RESULTS
  NMBAs have been shown to improve oxygenation during severe ARDS in three randomized controlled trials. The most recent results demonstrated that NMBAs decrease 90-day in-hospital mortality, particularly in the most hypoxaemic patients. NMBAs have not been shown to be an independent risk factor of neuromyopathy in most studies.
  
  
  CONCLUSIONS
  NMBAs are commonly used in ARDS (25-55% of patients), but the benefits and the risks of using these agents are controversial. Recent data suggest that a continuous infusion of cisatracurium during the first 48  h of ARDS, particularly for patients with a P(a)O(2)/F(i)O(2) ratio less than 120, can decrease 90-day in-hospital mortality. NMBAs do not appear to be an independent risk factor for ICU-acquired weakness if they are not given with corticosteroids or in patients with hyperglycaemia.
authors.affiliation: Aix-Marseille Univ, URMITE CNRS-UMR 6236, France.
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000707:Anaphylaxis; D003964:Diaphragm; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001261:Pulmonary Atelectasis; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000401:mortality; D012306:Risk; D013313:Stress Disorders, Post-Traumatic; D013997:Time Factors
chemical_list: D009466:Neuromuscular Blocking Agents