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Semin Respir Crit Care Med 2022; 43(03): 453-460
DOI: 10.1055/s-0042-1744304
Review Article

Prone Positioning and Neuromuscular Blocking Agents as Adjunctive Therapies in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome

Claude Guérin
1   Médecine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France
2   Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France
3   INSERM 955 CNRS 7200, Institut Mondor de Recherches Biomédicales, Créteil, France
,
Martin Cour
1   Médecine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France
2   Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France
,
Laurent Argaud
1   Médecine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France
2   Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France
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Abstract

Neuromuscular blocking agents (NMBAs) and prone position (PP) are two major adjunctive therapies that can improve outcome in moderate-to-severe acute respiratory distress syndrome. NMBA should be used once lung-protective mechanical ventilation has been set, for 48 hours or less and as a continuous intravenous infusion. PP should be used as early as possible for long sessions; in COVID-19 its use has exploded. In nonintubated patients, PP might reduce the rate of intubation but not mortality. The goal of this article is to perform a narrative review on the pathophysiological rationale, the clinical effects, and the clinical use and recommendations of both NMBA and PP.

Keywords

acute respiratory distress syndrome - prone position - neuromuscular blocking agents - lung protective ventilation - COVID-19


Publication History

Article published online:
29 May 2022

© 2022. Thieme. All rights reserved.

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