Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients
Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-09-01
|
| Series: | Journal of Personalized Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4426/12/9/1538 |
| _version_ | 1797486053078073344 |
|---|---|
| author | Vasiliki Tsolaki George E. Zakynthinos Maria-Eirini Papadonta Fotini Bardaka George Fotakopoulos Ioannis Pantazopoulos Demosthenes Makris Epaminondas Zakynthinos |
| author_facet | Vasiliki Tsolaki George E. Zakynthinos Maria-Eirini Papadonta Fotini Bardaka George Fotakopoulos Ioannis Pantazopoulos Demosthenes Makris Epaminondas Zakynthinos |
| author_sort | Vasiliki Tsolaki |
| collection | DOAJ |
| description | Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients’ self-inflicted lung injury. Moreover, NMBAs can harmonize the patient–ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the “war” conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS. |
| first_indexed | 2024-03-09T23:28:40Z |
| format | Article |
| id | doaj.art-c9b9bc116e4040138d59d1c86e67d2c5 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T23:28:40Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-c9b9bc116e4040138d59d1c86e67d2c52023-11-23T17:14:51ZengMDPI AGJournal of Personalized Medicine2075-44262022-09-01129153810.3390/jpm12091538Neuromuscular Blockade in the Pre- and COVID-19 ARDS PatientsVasiliki Tsolaki0George E. Zakynthinos1Maria-Eirini Papadonta2Fotini Bardaka3George Fotakopoulos4Ioannis Pantazopoulos5Demosthenes Makris6Epaminondas Zakynthinos7Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceCritical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceCritical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceCritical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceNeurosurgical Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceEmergency Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceCritical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceCritical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, GreeceAcute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients’ self-inflicted lung injury. Moreover, NMBAs can harmonize the patient–ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the “war” conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS.https://www.mdpi.com/2075-4426/12/9/1538neuromuscular blocking agentsmuscular relaxantsARDSsurvivallung injuryCOVID-19 ARDS |
| spellingShingle | Vasiliki Tsolaki George E. Zakynthinos Maria-Eirini Papadonta Fotini Bardaka George Fotakopoulos Ioannis Pantazopoulos Demosthenes Makris Epaminondas Zakynthinos Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients Journal of Personalized Medicine neuromuscular blocking agents muscular relaxants ARDS survival lung injury COVID-19 ARDS |
| title | Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients |
| title_full | Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients |
| title_fullStr | Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients |
| title_full_unstemmed | Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients |
| title_short | Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients |
| title_sort | neuromuscular blockade in the pre and covid 19 ards patients |
| topic | neuromuscular blocking agents muscular relaxants ARDS survival lung injury COVID-19 ARDS |
| url | https://www.mdpi.com/2075-4426/12/9/1538 |
| work_keys_str_mv | AT vasilikitsolaki neuromuscularblockadeinthepreandcovid19ardspatients AT georgeezakynthinos neuromuscularblockadeinthepreandcovid19ardspatients AT mariaeirinipapadonta neuromuscularblockadeinthepreandcovid19ardspatients AT fotinibardaka neuromuscularblockadeinthepreandcovid19ardspatients AT georgefotakopoulos neuromuscularblockadeinthepreandcovid19ardspatients AT ioannispantazopoulos neuromuscularblockadeinthepreandcovid19ardspatients AT demosthenesmakris neuromuscularblockadeinthepreandcovid19ardspatients AT epaminondaszakynthinos neuromuscularblockadeinthepreandcovid19ardspatients |