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Early neuromuscular blockade in the acute respiratory distress syndrome

New England Journal of Medicine May 24, 2019

Moss M, et al. - In patients with acute respiratory distress syndrome (ARDS) who are receiving mechanical ventilation, researchers explored the benefits of early continuous neuromuscular blockade. For this investigation, they randomized subjects with moderate-to-severe ARDS to a 48-hour continuous infusion of cisatracurium with concomitant deep sedation (intervention group) or to a usual-care approach without routine neuromuscular blockade and with lighter sedation targets (control group). Over 1,000 subjects early after the onset of moderate-to-severe ARDS were recruited. Among those with moderate-to-severe ARDS treated with a high positive end-expiratory pressure strategy, no significant difference was found with respect to mortality at 90 days between subjects who received an early and continuous cisatracurium infusion vs those who were treated with a usual-care approach with lighter sedation targets.

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