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

Claude Guérin; Martin Cour; Laurent Argaud

doi:10.1055/s-0042-1744304

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

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

¹Médecine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France

²Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France

³INSERM 955 CNRS 7200, Institut Mondor de Recherches Biomédicales, Créteil, France

,

Martin Cour

¹Médecine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France

²Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France

,

Laurent Argaud

¹Médecine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France

²Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France

› Institutsangaben

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

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Referenzen

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