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NMBA Duration Limit ARDS — FRCA Final MCQ

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ModerateIntensive Care MedicineNMBA Duration Limit ARDSFRCA Final

A 55-year-old woman in ICU with severe ARDS has been on neuromuscular blocking agents (cisatracurium infusion) for 36 hours to facilitate lung-protective ventilation. Regarding NMBA use in ARDS, what is the recommended maximum duration?

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Correct answer: B — 7 days

The ACURASYS trial (2010) used 48 hours of cisatracurium infusion in severe ARDS, which is the evidence-based maximum duration. Current guidelines (ICS/ATS 2024) recommend NMBAs for up to 48 hours in patients with severe ARDS (PaO2/FiO2 <150) who have ventilator dyssynchrony despite adequate sedation. Beyond 48 hours, the risk of ICU-acquired weakness (critical illness myopathy/polyneuropathy) increases significantly. NMBAs should be stopped as soon as possible and the depth of neuromuscular block monitored with TOF (targeting 1-2 twitches during infusion). The ROSE trial did not show benefit with a light sedation protocol.

Reference: Papazian L et al – 2010 – ACURASYS trial; ICS – 2024 – ARDS guidelines