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Controversies

One-Hour Concurrent Session

Pro/Con: Block It or Drop It? Debating Neuromuscular Blockade for Acute Respiratory Distress Syndrome

Monday, April 18, 2022

10:00 AM – 11:00 AM US CST

CE: 1.0

Concurrent Session Moderator(s)

Christine Groth, BCCCP, PharmD, FCCM

Clinical Pharmacy Coordinator
Strong Memorial Hospital of the University of Rochester
Rochester, NY

No relevant financial relationship(s) to disclose

The use of neuromuscular blocking agents (NMBAs) has been established as part of the treatment strategy for patients with acute respiratory distress syndrome (ARDS). However, the optimal approach to dosing NMBAs for patients is still controversial. The 2016 SCCM guidelines on the use of NMBAs did not discuss whether to use a continuous infusion (titrated or flat dose) or intermittent doses. The two major trials to date, ACURASYS and ROSE-PETAL, both used a continuous infusion (flat dose) approach. With numerous adverse effects associated with NMBAs, an intermittent strategy could be considered to reduce the total dose and lessen these adverse effects. Furthermore, the ROSE trial did not show benefit with a continuous infusion (flat dose) approach. This session will comprise two pro/con presentations that will address the therapeutic yield of neuromuscular blockade, dosing approaches to NMBAs in ARDS, and the monitoring and potential long-term sequelae of NMBAs.

Learning Objectives:

Explore the controversies surrounding the therapeutic benefit of neuromuscular blockade for acute respiratory distress syndrome (ARDS)
Compare administration strategies for neuromuscular blockade including intermittent doses and continuous infusions
Compare and contrast efficacy and discrepancies in the literature on paralysis in patients with ARDS

Presentations:

Con: Paralysis in ARDS: Is There Therapeutic Benefit? No or Negligible Therapeutic Benefit
Concurrent Session Faculty: Jolie Gallagher, PharmD, BCCCP – Northside Hospital Gwinnett
Pro: Paralysis in ARDS: Is There Therapeutic Benefit? Therapeutic Benefit
Concurrent Session Faculty: Marc Moss, MD (he/him/his) – University of Colorado Denver
Dosing Strategies for Paralytics in ARDS: Keep It Steady or Time for a Change? Benefits of Intermittent/TOF-Monitored Strategies
Concurrent Session Faculty: Heather Torbic, BCCCP, BCPS, PharmD – Cleveland Clinic
Dosing Strategies for Paralytics in ARDS: Keep It Steady or Time for a Change? Continuous/Flat-Dose Strategies
Concurrent Session Faculty: Brian Erstad, BCPS, PharmD, MCCM – University of Arizona College of Pharmacy