Neuromuscular Blocking Agents in ARDS

In this issue of the Journal, Papazian and colleagues 1 present intriguing results of their study examining neuromuscular blockade in patients with severe, early acute respiratory distress syndrome (ARDS). The investigators randomly assigned 340 patients to receive the neuromuscular blocking agent cisatracurium or placebo for a period of 48 hours. Both groups underwent mechanical ventilation according to a lung-protective strategy previously shown to decrease mortality. 2 Both the adjusted 90-day survival rate and time off the ventilator were greater in the cisatracurium group as compared with the placebo group. ARDS is an inflammatory disease characterized by pulmonary edema, stiff lungs, and hypoxemia. . . .