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NMBAs in ARDS Evidence — FRCA Final MCQ

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HardIntensive Care MedicineNMBAs in ARDS EvidenceFRCA Final

A 55-year-old man in the ICU has severe ARDS and is receiving neuromuscular blocking agents (cisatracurium) to facilitate lung-protective ventilation. What evidence supports the use of NMBAs in early severe ARDS?

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Correct answer: A — ACURASYS showed benefit but ROSE did not confirm it, leaving the evidence uncertain

The ACURASYS trial (2010) showed a mortality benefit with 48 hours of cisatracurium in early severe ARDS (PaO2/FiO2 <150). However, the larger ROSE trial (2019) using modern light sedation protocols did not confirm this benefit. The discrepancy may reflect changes in sedation practice (deep sedation in ACURASYS vs light sedation target in ROSE). Current consensus: NMBAs may be considered for 48 hours in severe ARDS with ventilator dyssynchrony despite adequate sedation, but routine use is not supported.

Reference: Papazian L et al – 2010 – ACURASYS; NHLBI PETAL Network – 2019 – ROSE trial; ICS – 2024 – ARDS guidelines