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Point/Counterpoint Editorials |

Counterpoint: Should Paralytic Agents Be Routinely Used in Severe ARDS? NoUse Paralytics for Severe ARDS: No

Curtis N. Sessler, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System.

Correspondence to: Curtis N. Sessler, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Medical College of Virginia Campus, Box 980050, Richmond, VA 23298; e-mail: csessler@vcu.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1442-1445. doi:10.1378/chest.13-1462
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Extract

The cornerstone of ARDS management is the delivery of positive pressure ventilation with sufficient inflation pressure to recruit and maintain alveoli in an inflated state while avoiding alveolar overdistension and associated pulmonary and systemic inflammation and barotrauma. Severe ARDS is characterized by profound hypoxemia that often is refractory to traditional management and, along with multiple organ failure, is a frequent cause of death.1 A variety of ventilatory and nonventilatory interventions have been used to improve oxygenation in severe ARDS, including the use of neuromuscular blocking agents (NMBAs).2,3 Such measures are typically applied on the basis of the patient’s severity of gas exchange derangement and other individualized factors rather than routinely administered. However, results from a placebo-controlled trial in which patients with severe ARDS randomized to receive the NMBA cisatracurium had superior outcomes have prompted this debate.4

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