Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, URMITE UMR CNRS 7278, Marseille, France.
Département d'anesthésie et de Réanimation, Réanimation Polyvalente, Institut Paoli-Calmettes, Marseille, France.
Intensive Care Med. 2017 Mar;43(3):408-418. doi: 10.1007/s00134-016-4653-4. Epub 2016 Dec 24.
To investigate whether neuromuscular blocking agents (NMBA) exert beneficial effects in acute respiratory distress syndrome (ARDS) by reason of their action on respiratory mechanics, particularly transpulmonary pressures (P ).
A prospective randomised controlled study in patients with moderate to severe ARDS within 48 h of the onset of ARDS. All patients were monitored by means of an oesophageal catheter and followed up for 48 h. Moderate ARDS patients were randomised into two groups according to whether they were given a 48-h continuous infusion of cisatracurium besylate or not (control group). Severe ARDS patients did not undergo randomisation and all received cisatracurium besylate per protocol. The changes during the 48-h study period in oxygenation and in respiratory mechanics, including inspiratory and expiratory P and driving pressure, were assessed and compared. Delta P (∆P ) was defined as inspiratory P minus expiratory P .
Thirty patients were included, 24 with moderate ARDS and 6 with severe ARDS. NMBA infusion was associated with an improvement in oxygenation in both moderate and severe ARDS, accompanied by a decrease in both plateau pressure and total positive end-expiratory pressure. The mean inspiratory and expiratory P were higher in the moderate ARDS group receiving NMBA than in the control group. In contrast, there was no change in either driving pressure or ∆P related to NMBA administration.
NMBA could exert beneficial effects in patients with moderate ARDS, at least in part, by limiting expiratory efforts.
研究神经肌肉阻滞剂（NMBA）是否通过对呼吸力学的作用，尤其是跨肺压（P ），对急性呼吸窘迫综合征（ARDS）产生有益效果。
这是一项在 ARDS 发病后 48 小时内的中度至重度 ARDS 患者中进行的前瞻性随机对照研究。所有患者均通过食管导管进行监测，并随访 48 小时。中度 ARDS 患者根据是否接受 48 小时持续输注顺苯磺酸阿曲库铵（对照组）随机分为两组。重度 ARDS 患者未进行随机分组，所有患者均按方案接受顺苯磺酸阿曲库铵。评估并比较了 48 小时研究期间氧合和呼吸力学（包括吸气和呼气 P 以及驱动压）的变化。吸气 P 减去呼气 P 定义为 ∆P （∆P ）。
共纳入 30 例患者，其中 24 例为中度 ARDS，6 例为重度 ARDS。NMBA 输注与中度和重度 ARDS 的氧合改善相关，同时平台压和总呼气末正压均降低。接受 NMBA 的中度 ARDS 组的平均吸气和呼气 P 均高于对照组。相比之下，驱动压或与 NMBA 给药相关的 ∆P 没有变化。
NMBA 可通过限制呼气努力对中度 ARDS 患者产生有益效果，至少部分如此。
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