18 to 100 years old
acute respiratory distress syndrome, muscle relaxant
Drug study, Phase 3
Blood tests Urine tests Medical record review Muscle Relaxer/Discouraged muscle relaxer Higher lung pressure settings on the mechanical ventilator to keep their lungs open and get more oxygen when on the breathing machine
Age > 18 years
Presence of all of the following conditions for < 48 hours:
i. PaO2/FiO2 /= 8 cm H2O OR, if ABG not available, SaO2/FiO2 ratio that is equivalent to a PaO2/FiO2 /= 8 cm H2O , and a confirmatory SaO2/FiO2 ratio that is again equivalent 1-6 hours later
ii. Bilateral opacities not fully explained by effusions, lobar/lung collapse, or nodules.
iii. Respiratory failure not fully explained by cardiac failure or fluid overload; need objective assessment (e.g., echocardiography) to exclude hydrostatic edema if no risk factor present.
Patients must be enrolled within 48 hours of meeting inclusion criteria.
Lack of informed consent
Continuous neuromuscular blockade at enrollment
Currently receiving ECMO therapy
Chronic respiratory failure defined as PaCO2 > 60 mm Hg in the outpatient setting
Home mechanical ventilation (non-invasive ventilation or via tracheotomy) except for CPAP/BIPAP used solely for sleep-disordered breathing
Actual body weight exceeding 1 kg per centimeter of height
Severe chronic liver disease defined as a Child-Pugh score of 12-15 (Appendix A2)
Bone marrow transplantation within the last 1 year
Expected duration of mechanical ventilation of < 48 hours
Decision to withhold life-sustaining treatment; except in those patients committed to full support except cardiopulmonary resuscitation if an actual cardiac arrest occurs
Moribund patient not expected to survive 24 hours; if CPR provided, assess for moribund status greater than 6 from CPR conclusion
Diffuse alveolar hemorrhage from vasculitis
Burns > 70% total body surface
Unwillingness to utilize the ARDS Network 6 ml/kg IBW ventilation protocol
Previous hypersensitivity or anaphylactic reaction to cisatracurium
Neuromuscular conditions that may potentiate neuromuscular blockade and/or impair spontaneous ventilation (Appendix A2)
Neurologic conditions undergoing treatment for intracranial hypertension
Enrollment in an interventional ARDS trial with direct impact on neuromuscular blockade and PEEP
120 hours of mechanical ventilation
P/F < 200 mmHg at the time of randomization (if available)
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