Guideline on neuromuscular blockade use in ARDS patients

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-03-10T20:30:47+05:30 | Updated On 10 March 2021 8:30 PM IST

Delhi: A panel of experts from 12 countries have released Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) for the use of neuromuscular blocking agents (NMBA) in adults with acute respiratory distress syndrome (ARDS). The guideline, published in the journal Intensive Care Medicine, is applicable for adults with early ARDS of any aetiology and severity who are receiving invasive mechanical ventilation in an ICU. The recommendations however do not apply to patients with pre-existing neuromuscular disease, those with a contraindication to neuromuscular blockade, or to children.

The aim of ICM-RPGs by Waleed Alhazzani, McMaster University, Hamilton, Canada, and colleagues was to produce trustworthy, rapid, and timely practice guidelines on topics that are of high priority to intensive care clinicians. The panel members adhered to a pre-planned and structured methodological approach to guideline development

Key recommendations and suggestions include:

The routine use of an NMBA infusion is not recommended in adults with ARDS before optimising mechanical ventilation and assessing ARDS severity.
In adults with moderate or severe ARDS who tolerate ventilation using a lighter sedation strategy the experts suggest against using an NMBA infusion.
If neuromuscular blockade is required to facilitate lung protective ventilation; the use of intermittent NMBA boluses is recommended with judicious deep sedation over an NMBA infusion with deep sedation.

"In this ICM-RPG, the panel issued one recommendation and two suggestions regarding the use of NMBA in ARDS. The current evidence does not support the early routine use of NMBA infusion in all adults with ARDS. It favours avoiding an NMBA infusion for patients who are ventilated using a lighter sedation strategy. However, for patients who require deep sedation to facilitate lung protective ventilation or prone positioning and require neuromuscular blockade, an infusion of an NMBA is a reasonable option," concluded the authors.

"Neuromuscular blockade in patients with ARDS: a rapid practice guideline," is published in the journal Intensive Care Medicine.

DOI: https://link.springer.com/article/10.1007/s00134-020-06227-8

Intensive Care Medicineneuromuscular blockadeacute respiratory distress syndrome

Source : Intensive Care Medicine

Medha Baranwal

MSc. Biotechnology

Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751