ICU SAQs · Sedation & paralysis
Neuromuscular blockade in severe ARDS — ACURASYS versus ROSE
A CICM Second-Part SAQ on neuromuscular blockade in ARDS — the ACURASYS mortality signal (31.6% vs 40.7%, HR 0.68), the larger ROSE trial showing no benefit (stopped early for futility), and the synthesis that routine early paralysis is not warranted; paralysis is reserved for refractory hypoxaemia or a high driving pressure.
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CICMFFICMEDIC
Prompt
Critically appraise the use of neuromuscular blockade in the patient with severe early ARDS. What is the evidence, and in which patients would you use it?
Question
Critically appraise the use of neuromuscular blockade in the patient with severe early ARDS. What is the evidence, and in which patients would you use it?
[2]References4ShowHide
- [1]Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome (ACURASYS). New England Journal of Medicine, 2010.PMID 20843245
- [2]Moss M, Huang DT, Brower RG, et al. Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome (ROSE). New England Journal of Medicine, 2019.PMID 31112383
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.