emThursday October 26, 2006
Neuromuscular blocking agents (NMBAs) in ARDS

We all dread and think twice before using NMBAs. But in this month (November 2006) of Critical Care Medicine 1, there is a prospective randomized trial of 36 patients published from france showing postive effect of neuromuscular blocking agents in patients presenting with acute respiratory distress syndrome.

A total of 36 patients with acute respiratory distress syndrome (Pao2/Fio2 ratio of less than / = 200 at a PEEP of more than/ = 5 cm H2O were included within 48 hrs of ARDS onset. Patients were randomized to receive

• conventional therapy plus placebo (n = 18) for 48 hrs or
• conventional therapy plus NMBAs (n = 18) for 48 hrs.

Both groups were ventilated with low tidal volume between 4 and 8 mL/kg.

Bronchoalveolar lavages and blood samples were performed, before randomization and at 48 hrs, to determine the concentrations of

• tumor necrosis factor-α,
• interleukin (IL)-1β,
• IL-6, and
• IL-8

Pao2/Fio2 ratio was evaluated before randomization and at 24, 48, 72, 96, and 120 hrs.


At 48 hrs after randomization, pulmonary concentrations of IL-1β, IL-6 and IL-8 were lower in the NMBA group as compared with the control group. Similar pattern noticed in serum samples. Importantly, a sustained improvement in Pao2/Fio2 ratio was observed in the NMBA group upto 120 hours.

Reference: click to get abstract
Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome - Critical Care Medicine. 34(11):2749-2757, November 2006