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Pharmacological Interventions: Neuromuscular Blocking Agents

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Acute Respiratory Distress Syndrome

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Abstract

Neuromuscular blocking agents (NMBAs) are extensively used in patients who present with acute respiratory distress syndrome (ARDS). The role of NMBAs has been extensively discussed in the past, primarily due to their potential adverse effects and the absence of clear evidence regarding their influence on prognosis. However, recent data have demonstrated that NMBAs are associated with a reduction in mortality in the most severe patients. Currently, the role of paralytics in the care of ARDS patients is proven. The positive effects of paralytics are probably due to the facilitation of protective ventilation, the prevention of ventilator-induced lung injury and the limitation of derecruitment. However, the role of NMBAs should be limited to severe and most hypoxaemic forms of moderate ARDS. NMBAs probably have a crucial role to play in the acute phase of ARDS, i.e. during the climax of lung injury, especially in association with other therapies, such as prone positioning. The use of NMBAs should always be integrated into the overall management strategy for the mechanical ventilation of ARDS patients, and NMBAs should be discontinued as soon as the patient improves sufficiently to allow for partial spontaneous breathing.

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Authors and Affiliations

  1. Assistance Publique – Hôpitaux de Marseille, Hôpital Nord, Réanimation – Détresses Respiratoires et des Infections Sévères, Chemin des Bourrely, 13015, Marseille, France

    Samuel Lehingue MD, Sami Hraiech MD, PhD & Laurent Papazian MD, PhD

  2. Aix-Marseille Université, Faculté de Médecine de Marseille, 22 boulevard Jean Moulin, 13305, Marseille, France

    Samuel Lehingue MD, Sami Hraiech MD, PhD & Laurent Papazian MD, PhD

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  1. Samuel Lehingue MD
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  2. Sami Hraiech MD, PhD
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  3. Laurent Papazian MD, PhD
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Correspondence to Sami Hraiech MD, PhD .

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Editors and Affiliations

  1. Department of "Scienze della Salute", University of Milan, Director of Anaesthesia and Intensive Care Services , ASST Santi Paolo e Carlo, Milan, Italy

    Davide Chiumello

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Lehingue, S., Hraiech, S., Papazian, L. (2017). Pharmacological Interventions: Neuromuscular Blocking Agents. In: Chiumello, D. (eds) Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-41852-0_12

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  • DOI: https://doi.org/10.1007/978-3-319-41852-0_12

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