The early use of neuromuscular blocking agents in the setting of moderate-to-severe acute respiratory distress syndrome (ARDS) was previously understood to confer a survival advantage at 90 days, based on the outcomes of the 2010 ACURASYS trial.

The ROSE trial – the largest randomized controlled trial of neuromuscular blockade in ARDS – re-examines this in the setting of a much larger patient population with high adherence to newer ARDS management guidelines, providing an updated and more validated insight to the role of neuromuscular blockade in ARDS.

Though the early use of neuromuscular blockade has been recommended following the ACURASYS trial, the study suggested that neuromuscular blockade conferred a mortality benefit compared to a strategy of deep sedation targets. The current guidelines for ARDS management recommend lighter sedation targets, and thus the continued use of neuromuscular blockade has been conflated for a mortality benefit over outdated sedation guidelines.

The ROSE trial demonstrates that early neuromuscular blockade yielded no significant difference in 90-day mortality compared to light sedation targets in adherence with updated guidelines.

Read More