Takeaway
- Among patients with acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation (MV) with high positive end-expiratory pressure (PEEP), neuromuscular blockade (NMB) did not lower mortality vs usual care with lighter sedation.
- Editorial :
- Suggests difference in sedation vs ACURASYS could explain discordant results.
- Recommends against routine NMB in moderate-to-severe ARDS, unless breath stacking or increased respiratory drive.
- Postulates dyssynchrony may affect outcomes.
Why this matters
- In ACURASYS (2010), NMB reduced ARDS mortality vs deep sedation alone, yet intervention seldom used:
- Modern practice favors lighter sedation.
- Little is known about NMB's downstream outcomes.
Study design
- Randomized multicenter controlled open-label ROSE trial (n=1006).
- Researchers randomly assigned participants with moderate-to-severe ARDS undergoing MV to either:
- 48-hour continuous cisatracurium (Nimbex; AbbVie, Inc.) plus deep sedation, or
- Usual care without routine NMB; with lighter sedation (controls).
- Both groups underwent high-PEEP mechanical ventilation, conservative fluid strategy.
- Outcome: 90-day in-hospital mortality.
- Funding: NIH.
Key results
- High protocol adherence.
- Trial halted for futility.
- Cisatracurium vs control:
- Primary outcome: 42.5% vs 42.8%; between-group difference, −0.3% (95% CI, −6.4 to 5.9; P=.93).
- Serious cardiovascular events: 14 vs 4 (P=.02).
- No differences in 28-day hospital mortality; ventilation-, ICU-, or hospital-free days; pneumothorax; barotrauma.
- 1 death possibly related to cisatracurium.
Limitations
- Open-label.
Only healthcare professionals with a Univadis account have access to this article.
You have reached your limit of complementary articles
Free Sign Up Available exclusively to healthcare professionalsLogin to
account
Don’t have an account? Get started