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Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome*

Gainnier, Marc MD; Roch, Antoine MD; Forel, Jean-Marie MD; Thirion, Xavier MD, PhD; Arnal, Jean-Michel MD; Donati, Stéphane MD; Papazian, Laurent MD, PhD

doi: 10.1097/01.CCM.0000104114.72614.BC

Objective To evaluate the effects of a 48-hr neuromuscular blocking agents (NMBA) infusion on gas exchange over a 120-hr time period in patients with acute respiratory distress syndrome.

Design Multiple center, prospective, controlled, and randomized trial.

Setting Four adult medical or mixed medical-surgical intensive care units.

Patients A total of 56 patients with acute respiratory distress syndrome with a Pao2/Fio2 ratio of <150 at a positive end-expiratory pressure of ≥5 cm H2O.

Interventions After randomization, patients received either conventional therapy without NMBA (control group) or conventional therapy plus NMBA for the next 48 hrs. The initial ventilator mode was volume-assist/control. The ventilator remained on assist-control mode throughout the initial 48-hr period in both groups. Tidal volume was 6–8 mL/kg ideal body weight.

Measurements and Main Results When analyzed for the entire 120 hrs, there was a significant effect of the NMBA on the course of Pao2/Fio2 ratio (p = .021). Separate comparisons at each time point indicated that patients randomized to the NMBA group had a higher Pao2/Fio2 at 48, 96, and 120 hrs after randomization. Moreover, a decrease of positive end-expiratory pressure (p = .036) was only found in the NMBA group. Two-way repeated-measures analysis of variance exhibited a decrease in positive end-expiratory pressure over time (p = .036). Concerning short-term effects, there was no modification of Pao2/Fio2 ratio 1 hr after randomization in either group. Only one patient (from the control group) developed pneumothorax.

Conclusions Use of NMBA during a 48-hr period in patients with acute respiratory distress syndrome is associated with a sustained improvement in oxygenation.

From Service de Réanimation Médicale (MG, LP), Service de Réanimation Polyvalente (AR), and Service d’Information Médicale (XT), Hôpitaux Sud, Marseille, France; Service de Réanimation, Institut Paoli-Calmettes, Marseille, France (JMF); and Service de Réanimation, Hôpital Font Pré, Toulon, France (JMA, SD).

Supported, in part, by Assistance Publique–Hôpitaux de Marseille, Marseille, France.

Address requests for reprints to: Laurent Papazian, MD, PhD, Réanimation Médicale, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 9, France. E-mail:

Use of neuromuscular blocking agents during a 48-hr period in patients with acute respiratory distress syndrome is associated with a sustained improvement in oxygenation.

© 2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins