Neuromuscular blockade in patients with ARDS: a rapid practice guideline

Area of Science:

• Critical Care Medicine
• Pulmonology
• Pharmacology

Background:

• Acute Respiratory Distress Syndrome (ARDS) management involves mechanical ventilation and sedation.
• Neuromuscular blocking agents (NMBAs) are sometimes used in ARDS, but their optimal role requires clarification.
• Existing evidence on NMBA use in ARDS is limited, necessitating evidence-based guidance.

Purpose of the Study:

• To provide evidence-based guidance on the use of neuromuscular blocking agents (NMBAs) in adult patients with ARDS.
• To develop recommendations and suggestions for clinicians managing ARDS.
• To address the uncertainty surrounding NMBA administration in ARDS.

Main Methods:

• Formulation of an Intensive Care Medicine Rapid Practice Guideline (ICM-RPG).
• Convening a panel of 20 international clinical experts and 2 patient representatives.
• Utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and evidence-to-decision framework.

Main Results:

• The overall certainty of the evidence was low.
• One recommendation and two suggestions were issued regarding NMBA use in ARDS.
• Current evidence does not support the early routine use of NMBA infusion in adults with ARDS.

Conclusions:

• Avoid continuous NMBA infusion in ARDS patients managed with lighter sedation strategies.
• Consider a 48-hour NMBA infusion for ARDS patients requiring deep sedation for lung-protective ventilation or prone positioning.
• Further research is needed to clarify the role and optimal use of NMBAs in ARDS.