Early Paralytic Agents for ARDS? Yes, No, and Sometimes

Lung-protective ventilation, which includes low tidal volumes and limitation of plateau pressures, is the standard approach in patients with acute respiratory distress syndrome (ARDS).(1) Almost a decade ago, the ARDS et Curarisation Systematique (ACURASYS) trial(2) showed that in patients with moderate-to-severe ARDS, a strategy of 48 hours of deep sedation with muscle paralysis induced by an intravenous infusion of cisatracurium resulted in a lower incidence of barotrauma and higher adjusted overall survival at 90 days than deep sedation alone. These results were unexpected, since the intervention was performed only for the first 2 days, yet the Kaplan-Meier survival curves were . . .