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Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome.

Jean-Marie Forel·Antoine Roch·Valérie Marin·Pierre Michelet·Didier Demory·Jean-Louis Blache·Gilles Perrin·Marc Gainnier·Pierre Bongrand·Laurent Papazian
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Abstract

OBJECTIVE: To evaluate the effects of neuromuscular blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy. DESIGN: Multiple-center, prospective, controlled, and randomized trial. SETTING: One medical and two medical-surgical intensive care units. PATIENTS: A total of 36 patients with acute respiratory distress syndrome (Pao2/Fio2 ratio of < or =200 at a positive end-expiratory pressure of > or =5 cm H2O) were included within 48 hrs of acute respiratory distress syndrome onset. INTERVENTIONS: Patients were randomized to receive conventional therapy plus placebo (n = 18) or conventional therapy plus NMBAs (n = 18) for 48 hrs. Both groups were ventilated with a lung-protective strategy (tidal volume between 4 and 8 mL/kg ideal body weight, plateau pressure of < or =30 cm H2O). MEASUREMENTS AND MAIN RESULTS: Bronchoalveolar lavages and blood samples were performed, before randomization and at 48 hrs, to determine the concentrations of tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, and IL-8. Pao2/Fio2 ratio was evaluated before randomization and at 24, 48, 72, 96, and 120 hrs. A decrease over time in IL-8 concentrations (p = .034) was observed in the pulmonary compartment of the NMBA group. At 48 hrs after randomization, pulmonary concentrations of IL-1beta (p = .005), IL-6 (p = .038), and IL-8 (p = .017) were lower in the NMBA group as compared with the control group. A decrease over time in IL-6 (p = .05) and IL-8 (p = .003) serum concentrations was observed in the NMBA group. At 48 hrs after randomization, serum concentrations of IL-1beta (p = .037) and IL-6 (p = .041) were lower in the NMBA group as compared with the control group. A sustained improvement in Pao2/Fio2 ratio was observed and was reinforced in the NMBA group (p < .001). CONCLUSION: Early use of NMBAs decrease the proinflammatory response associated with acute respiratory distress syndrome and mechanical ventilation.

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CytokinesDouble-Blind MethodFemaleHumansInflammationMaleMiddle AgedNeuromuscular Blocking AgentsOxygenPositive-Pressure RespirationProspective StudiesRespiratory Distress SyndromeJournal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, Non-U.S. Gov't

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Jean-Marie Forel, Antoine Roch, Valérie Marin, Pierre Michelet, Didier Demory, Jean-Louis Blache, Gilles Perrin, Marc Gainnier, Pierre Bongrand, Laurent Papazian. 2006. Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome.. https://doi.org/10.1097/01.ccm.0000239435.87433.0d

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