Neuromuscular blocker agents in mechanically ventilated patients with ARDS

The clinical use of neuromuscular blocker agents (NMBAs) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) is a controversial topic in critical care medicine. Of the two classes of NMBAs, the most widely used are the non-depolarizing agents including cisatracurium. Some of the benefits attributed to this class of medications for patients with ARDS include a decreased inflammatory response, prevention of ventilator dyssynchrony, and improved oxygenation. The mortality benefit of this intervention was recently studied by two main trials, ACURASYS and ROSE, which showed improved patient outcomes, but no mortality benefit was obtained. The decision to use NMBAs in the clinical practice has to be made in a case-by-case basis taking in consideration different scenarios.