Myorelaxants in ARDS patients
Neuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-in...
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| Veröffentlicht in: | Intensive care medicine 2020-12, Vol.46 (12), p.2357-2372 |
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| creator | Hraiech, Sami Yoshida, Takeshi Annane, Djillali Duggal, Abhijit Fanelli, Vito Gacouin, Arnaud Heunks, Leo Jaber, Samir Sottile, Peter D. Papazian, Laurent |
| description | Neuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-induced lung injury (VILI) results in a lower incidence of barotrauma, improved oxygenation and a decrease in circulating proinflammatory markers. Recent randomized clinical trials did not reveal harmful muscular effects during a short course of NMBAs. The use of NMBAs should be considered during the early phase of severe ARDS for patients to facilitate lung protective ventilation or prone positioning only after optimising mechanical ventilation and sedation. The use of NMBAs should be integrated in a global strategy including the reduction of tidal volume, the rational use of PEEP, prone positioning and the use of a ventilatory mode allowing spontaneous ventilation as soon as possible. Partial neuromuscular blockade should be evaluated in future trials. |
| doi_str_mv | 10.1007/s00134-020-06297-8 |
| format | Article |
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Minimization of volutrauma and ventilator-induced lung injury (VILI) results in a lower incidence of barotrauma, improved oxygenation and a decrease in circulating proinflammatory markers. Recent randomized clinical trials did not reveal harmful muscular effects during a short course of NMBAs. The use of NMBAs should be considered during the early phase of severe ARDS for patients to facilitate lung protective ventilation or prone positioning only after optimising mechanical ventilation and sedation. The use of NMBAs should be integrated in a global strategy including the reduction of tidal volume, the rational use of PEEP, prone positioning and the use of a ventilatory mode allowing spontaneous ventilation as soon as possible. Partial neuromuscular blockade should be evaluated in future trials.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-020-06297-8</identifier><identifier>PMID: 33159530</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acute respiratory distress syndrome ; Anesthesiology ; Barotrauma ; Clinical trials ; Critical Care Medicine ; Emergency Medicine ; Humans ; Inflammation ; Intensive ; Intensive care ; Life Sciences ; Lungs ; Mechanical ventilation ; Medicine ; Medicine & Public Health ; Neuromuscular blocking agents ; Neuromuscular Blocking Agents - adverse effects ; Optimization ; Oxygenation ; Pain Medicine ; Patient positioning ; Pediatrics ; Pneumology/Respiratory System ; Respiration, Artificial ; Respiratory distress syndrome ; Respiratory Distress Syndrome - therapy ; Review ; Tidal Volume ; Ventilation ; Ventilator-Induced Lung Injury - prevention & control ; Ventilators</subject><ispartof>Intensive care medicine, 2020-12, Vol.46 (12), p.2357-2372</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>COPYRIGHT 2020 Springer</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c613t-62c0177ef977e781852d2a3a58156b3548cb90f7c33aac3d4c4f29780578d3ec3</citedby><cites>FETCH-LOGICAL-c613t-62c0177ef977e781852d2a3a58156b3548cb90f7c33aac3d4c4f29780578d3ec3</cites><orcidid>0000-0002-8125-9406 ; 0000-0001-6805-8944 ; 0000-0003-4220-2359 ; 0000-0002-7257-8069</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-020-06297-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-020-06297-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33159530$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-02995380$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Hraiech, Sami</creatorcontrib><creatorcontrib>Yoshida, Takeshi</creatorcontrib><creatorcontrib>Annane, Djillali</creatorcontrib><creatorcontrib>Duggal, Abhijit</creatorcontrib><creatorcontrib>Fanelli, Vito</creatorcontrib><creatorcontrib>Gacouin, Arnaud</creatorcontrib><creatorcontrib>Heunks, Leo</creatorcontrib><creatorcontrib>Jaber, Samir</creatorcontrib><creatorcontrib>Sottile, Peter D.</creatorcontrib><creatorcontrib>Papazian, Laurent</creatorcontrib><title>Myorelaxants in ARDS patients</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Neuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-induced lung injury (VILI) results in a lower incidence of barotrauma, improved oxygenation and a decrease in circulating proinflammatory markers. Recent randomized clinical trials did not reveal harmful muscular effects during a short course of NMBAs. The use of NMBAs should be considered during the early phase of severe ARDS for patients to facilitate lung protective ventilation or prone positioning only after optimising mechanical ventilation and sedation. The use of NMBAs should be integrated in a global strategy including the reduction of tidal volume, the rational use of PEEP, prone positioning and the use of a ventilatory mode allowing spontaneous ventilation as soon as possible. Partial neuromuscular blockade should be evaluated in future trials.</description><subject>Acute respiratory distress syndrome</subject><subject>Anesthesiology</subject><subject>Barotrauma</subject><subject>Clinical trials</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Life Sciences</subject><subject>Lungs</subject><subject>Mechanical ventilation</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuromuscular blocking agents</subject><subject>Neuromuscular Blocking Agents - adverse effects</subject><subject>Optimization</subject><subject>Oxygenation</subject><subject>Pain Medicine</subject><subject>Patient positioning</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Respiration, Artificial</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory Distress Syndrome - 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| subjects | Acute respiratory distress syndrome Anesthesiology Barotrauma Clinical trials Critical Care Medicine Emergency Medicine Humans Inflammation Intensive Intensive care Life Sciences Lungs Mechanical ventilation Medicine Medicine & Public Health Neuromuscular blocking agents Neuromuscular Blocking Agents - adverse effects Optimization Oxygenation Pain Medicine Patient positioning Pediatrics Pneumology/Respiratory System Respiration, Artificial Respiratory distress syndrome Respiratory Distress Syndrome - therapy Review Tidal Volume Ventilation Ventilator-Induced Lung Injury - prevention & control Ventilators |
| title | Myorelaxants in ARDS patients |
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