Probability of benefit with the use of neuromuscular blockade in patients with acute respiratory distress syndrome

The acute respiratory distress syndrome (ARDS) is a diffuse inflammatory condition of the lungs presenting with hypoxemia and bilateral chest infiltrates, which is characterized by nonhydrostatic pulmonary edema, increased volume of collapsed alveolar units, decreased functional residual capacity and increased dead space (1). Generally, ARDS represents 10.4% of intensive care unit (ICU) admissions and 23.4% of patients requiring mechanical ventilation (2). Patients with ARDS have a high in-hospital mortality, ranging from 34.9% in milder cases to more than 45% in the most severe cases (2). Also, ARDS survivors report reduced health-related quality of life even after 2 years of hospital discharge (3). Its treatment remains mainly supportive and the avoidance of ventilator-induced lung injury (VILI) while keeping acceptable gas exchange through adequate adjustments of the mechanical ventilator plays a critical role (1).