To Block or Not: Updates in Neuromuscular Blockade in Acute Respiratory Distress Syndrome.

摘要: Objective: To review and evaluate neuromuscular blocking agents (NMBAs) in critically ill patients with acute respiratory distress syndrome (ARDS). Data Sources: A literature search utilizing PubMed was performed (January 1991 to January 2020) using the following terms: (neuromuscular OR blockade cisatracurium rocuronium vecuronium pancuronium atracurium) AND *acute lung injury). Publications English were evaluated. Study Selection Extraction: Relevant clinical studies humans considered. Synthesis: Although NMBAs have been used for decades setting of ARDS, questions regarding mortality benefit remain. Early NMBA, within 48 hours injury, historically ARDS aid increasing alveolar recruitment, improving patient-ventilator synchrony, promoting oxygenation by prevention contraction muscles. Until recently, showed an improvement 90-day adjusted mortality. However, recent has demonstrated lack a benefit. The continued receipt NMBAs, no clear benefit, could potentially lead increased costs, skin breakdown, corneal abrasions, venous thromboembolisms, intensive care unit acquired weakness, awareness inappropriate sedation. Relevance Patient Care Clinical Practice: This aims at discussing preferred NMBA based on mechanism action reviews specific trial data use implications these data, complications needed future directions. Conclusions: contradicting evidence serious adverse effects notable controversies.