LAUSR

Early continuous neuromuscular blockade in mechanically ventilated patients with acute respiratory distress syndrome (ARDS) is commonly used but its benefits remain unclear. This study randomized 1,006 patients with moderate-to-severe ARDS to a 48-h continuous infusion of cisatracurium plus deep sedation or to usual care (no routine neuromuscular blockade and lighter sedation). The authors used the same mechanical ventilation strategies in both groups. Within 48 h of randomization, 488 intervention patients (97.4%) started a continuous infusion of cisatracurium and 86 control patients (17.0%) received a neuromuscular blocking agent. At 90 days, nearly identical numbers of patients in both groups had died: 213 (42.5%) in the experimental group and 216 (42.8%) in the control group. This was a between-group difference of –0.3 points; 95% CI, –6.4 to 5.9; P = 0.93. Accordingly, the study was stopped at the second interim analysis due to futility. Interestingly, intervention patients were less physically active yet had more cardiovascular events than control patients during their hospitalization. (Article Selection: Laszlo Vutskits. Image: J. P. Rathmell.) Take home message: There were no differences in 90-day mortality among patients with moderate-to-severe ARDS who were treated with early, continuous neuromuscular blockade and those who were treated with a usual care approach that included lighter sedation targets.