Q: Which of the following has shown favorable outcome towards mortality in Acute Respiratory Distress Syndrome (ARDS)?
E) Use of no Neuro-Muscular Blockade (NMB)
NMB are not very desirable for use in ICUs but in some situations they become life savers like severe ARDS. Interestingly, they have shown some favorable tendency in decreasing mortality in these patients.
In 2010 trial of 340 patients, group treated with cisatracurium had more ventilator-free days in first 90 days, less barotrauman but more importantly no difference in the ICU-acquired neuromuscular weakness. Another meta-analysis of five trials also reported improved mortality.
Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010; 363:1107.
Tao W, Yang LQ, Gao J, Shao J. Neuromuscular blocking agents for adult patients with acute respiratory distress syndrome: A meta-analysis of randomized controlled trials. J Trauma Acute Care Surg 2018; 85:1102.