Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome

摘要: Background In patients undergoing mechanical ventilation for the acute respiratory distress syndrome (ARDS), neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but also cause muscle weakness. We evaluated clinical outcomes after 2 days of therapy with in early, severe ARDS. Methods this multicenter, double-blind trial, 340 presenting to intensive care unit (ICU) an onset ARDS within previous 48 hours were randomly assigned receive, hours, either cisatracurium besylate (178 patients) or placebo (162 patients). Severe was defined as a ratio partial pressure arterial oxygen (PaO ) fraction inspired (FiO less than 150, positive end-expiratory 5 cm more water tidal volume 6 8 ml per kilogram predicted body weight. The primary outcome proportion who died before hospital discharge 90 study enrollment (i.e., 90-day in-hospital mortality rate), adjusted predefined covariates baseline differences between groups use Cox model. Results hazard death at group, compared 0.68 (95% confidence interval [CI], 0.48 0.98; P = 0.04), adjustment both PaO :FIO plateau Simplified Acute Physiology II score. crude 31.6% CI, 25.2 38.8) group 40.7% 33.5 48.4) (P 0.08). Mortality 28 23.7% 18.1 30.5) 33.3% 26.5 40.9) 0.05). rate ICU-acquired paresis did not differ significantly two groups. Conclusions ARDS, early administration agent improved survival increased time off ventilator without increasing (Funded by Assistance Publique–Hopitaux de Marseille Programme Hospitalier Recherche Clinique Regional 2004-26 French Ministry Health; ClinicalTrials.gov number, NCT00299650.)