title: Effects of neuromuscular blockers on transpulmonary pressures in moderate to severe acute respiratory distress syndrome.
abstract: OBJECTIVE
  To investigate whether neuromuscular blocking agents (NMBA) exert beneficial effects in acute respiratory distress syndrome (ARDS) by reason of their action on respiratory mechanics, particularly transpulmonary pressures (PL).
  
  
  METHODS
  A prospective randomised controlled study in patients with moderate to severe ARDS within 48 h of the onset of ARDS. All patients were monitored by means of an oesophageal catheter and followed up for 48 h. Moderate ARDS patients were randomised into two groups according to whether they were given a 48-h continuous infusion of cisatracurium besylate or not (control group). Severe ARDS patients did not undergo randomisation and all received cisatracurium besylate per protocol. The changes during the 48-h study period in oxygenation and in respiratory mechanics, including inspiratory and expiratory PLand driving pressure, were assessed and compared. Delta PL(∆PL) was defined as inspiratory PLminus expiratory PL.
  
  
  RESULTS
  Thirty patients were included, 24 with moderate ARDS and 6 with severe ARDS. NMBA infusion was associated with an improvement in oxygenation in both moderate and severe ARDS, accompanied by a decrease in both plateau pressure and total positive end-expiratory pressure. The mean inspiratory and expiratory PLwere higher in the moderate ARDS group receiving NMBA than in the control group. In contrast, there was no change in either driving pressure or ∆PLrelated to NMBA administration.
  
  
  CONCLUSIONS
  NMBA could exert beneficial effects in patients with moderate ARDS, at least in part, by limiting expiratory efforts.
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France. christophe.guervilly@ap-hm.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Guervilly
authors.affiliation: Département d'anesthésie et de Réanimation, Réanimation Polyvalente, Institut Paoli-Calmettes, Marseille, France.|Réanimation des Urgences et Medicale, CHU la Timone 2 Marseille, Aix-Marseille Université, 13385, Marseille, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Bisbal
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Forel
authors.affiliation: Réanimation des Urgences et Medicale, CHU la Timone 2 Marseille, Aix-Marseille Université, 13385, Marseille, France.
authors.forename: Malika
authors.initials: M
authors.lastname: Mechati
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lehingue
authors.affiliation: Réanimation des Urgences et Medicale, CHU la Timone 2 Marseille, Aix-Marseille Université, 13385, Marseille, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Bourenne
authors.affiliation: Réanimation des Urgences et Medicale, CHU la Timone 2 Marseille, Aix-Marseille Université, 13385, Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Perrin
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Rambaud
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
authors.forename: Melanie
authors.initials: M
authors.lastname: Adda
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
authors.forename: Elisa
authors.initials: E
authors.lastname: Marchi
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.|Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Accueil des Urgence, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.affiliation: Réanimation des Urgences et Medicale, CHU la Timone 2 Marseille, Aix-Marseille Université, 13385, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Gainnier
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000494:pharmacology*; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D011652:Pulmonary Circulation; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D015656:Respiratory Mechanics / Q000187:drug effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium
keywords: Acute respiratory distress syndrome; Driving pressure; Esophageal pressure; Neuromuscular blocking agent; Transpulmonary pressure