Pharmacological Interventions: Neuromuscular Blocking Agents

  • Samuel Lehingue
  • Sami Hraiech
  • Laurent Papazian


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.


Acute Respiratory Distress Syndrome Spontaneous Breathing Functional Residual Capacity Acute Respiratory Distress Syndrome Patient Plateau Pressure 
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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Samuel Lehingue
    • 1
    • 2
  • Sami Hraiech
    • 1
    • 2
  • Laurent Papazian
    • 1
    • 2
  1. 1.Assistance Publique – Hôpitaux de MarseilleHôpital Nord, Réanimation – Détresses Respiratoires et des Infections SévèresMarseilleFrance
  2. 2.Aix-Marseille Université, Faculté de Médecine de MarseilleMarseilleFrance

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