Reevaluation Of Systemic Early Neuromuscular Blockade

Exclusion Criteria

• •1. Lack of informed consent
• •2. Continuous neuromuscular blockade at enrollment
• •3. Known pregnancy
• •4. Currently receiving ECMO therapy
• •5. Chronic respiratory failure defined as PaCO2 \> 60 mm Hg in the outpatient setting
• •6. Home mechanical ventilation (non-invasive ventilation or via tracheotomy) except for CPAP/BIPAP used solely for sleep-disordered breathing
• •7. Actual body weight exceeding 1 kg per centimeter of height
• •8. Severe chronic liver disease defined as a Child-Pugh score of 12-15 (Appendix A2)
• •9. Bone marrow transplantation within the last 1 year
• •10. Expected duration of mechanical ventilation of \< 48 hours
• •11. Decision to withhold life-sustaining treatment; except in those patients committed to full support except cardiopulmonary resuscitation if an actual cardiac arrest occurs
• •12. Moribund patient not expected to survive 24 hours; if CPR provided, assess for moribund status greater than 6 from CPR conclusion
• •13. Diffuse alveolar hemorrhage from vasculitis
• •14. Burns \> 70% total body surface
• •15. Unwillingness to utilize the ARDS Network 6 ml/kg IBW ventilation protocol
• •16. Previous hypersensitivity or anaphylactic reaction to cisatracurium
• •17. Neuromuscular conditions that may potentiate neuromuscular blockade and/or impair spontaneous ventilation (Appendix A2)
• •18. Neurologic conditions undergoing treatment for intracranial hypertension
• •19. Enrollment in an interventional ARDS trial with direct impact on neuromuscular blockade and PEEP
• •20. \>120 hours of mechanical ventilation
• •21. P/F \< 200 mmHg at the time of randomization (if available)