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

• DOI: 10.1097/01.ccm.0000104114.72614.bc
• Publication Date: 2004-01-07T09:05:41Z
• Authors: Marc Gainnier; Antoine Roch; Jean-Marie Forel; Xavier Thirion; Jean-Michel Arnal; Stéphane Donati; Laurent Papazian
• Keywords: Adult; Male; Respiratory Distress Syndrome; Critical Care; Pulmonary Gas Exchange; Middle Aged; Combined Modality Therapy; Respiration, Artificial; 3. Good health; Intensive Care Units; 03 medical and health sciences; Oxygen Consumption; 0302 clinical medicine; Reference Values; Acute Disease; Humans; Female; Prospective Studies; Blood Gas Analysis; Neuromuscular Blocking Agents; Aged; Follow-Up Studies; Probability

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.Multiple center, prospective, controlled, and randomized trial.Four adult medical or mixed medical-surgical intensive care units.A total of 56 patients with acute respiratory distress syndrome with a PaO2/FiO2 ratio of <150 at a positive end-expiratory pressure of > or =5 cm H2O.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.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.Use of NMBA during a 48-hr period in patients with acute respiratory distress syndrome is associated with a sustained improvement in oxygenation.