Early Neuromuscular Blockade Not Superior in ARDS With Ventilation

Ventilation, ICU
Mortality was similar in patients receiving continuous infusion of cisatracurium and those receiving lighter sedation targets.

HealthDay News — For patients with moderate-to-severe acute respiratory distress syndrome (ARDS) receiving mechanical ventilation, there is no difference in mortality between those receiving continuous infusion of cisatracurium and those receiving an approach with lighter sedation targets, according to a study published online May 19 in the New England Journal of Medicine. The research was published to coincide with the American Thoracic Society 2019 International Conference, held from May 17 to 22 in Dallas.

Marc Moss, M.D., from the University of Colorado School of Medicine in Aurora, and colleagues randomly assigned patients with moderate-to-severe ARDS to either a 48-hour infusion of cisatracurium with concomitant deep sedation or a usual care approach without routine neuromuscular blockade and with lighter sedation targets (intervention and control groups, respectively). A total of 1,006 patients were enrolled early after onset of moderate-to-severe ARDS. During the first 48 hours after random assignment, 97.4 percent of patients in the intervention group started cisatracurium and 17.0 percent of the control group received a neuromuscular blocking agent.

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At the second interim analysis, the trial was stopped for futility. The researchers found that at 90 days, 42.5 and 42.8 percent of patients in the intervention and control groups had died before hospital discharge, respectively (between-group difference, −0.3 percent; 95 percent confidence interval, −6.4 to 5.9; P = 0.93).

“Our trial finally settles it — light sedation with intermittent, short-term paralysis if necessary is as good as deep sedation with continuous paralysis,” a coauthor said in a statement.

Several authors disclosed financial ties to the pharmaceutical and medical technology industries.

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