Clinical study of early use of neuromuscular blocking agents in patients with severe sepsis and acute respiratory distress syndrome.

OBJECTIVE: To observe the clinical effects of early use of neuromuscular blocking agents (NMBA) in patients with severe sepsis and acute respiratory distress syndrome (ARDS). METHODS: A prospective study was conducted. 96 patients with severe sepsis and ARDS admitted from July 2012 to September 2013 to intensive care unit (ICU) of Liuzhou People's Hospital in Guangxi Zhuang Autonomous Region were enrolled and divided into severe ARDS group (n=48) and moderate ARDS group (n=48) according to the Berlin definition of ARDS. Then patients in each group were randomly divided into treatment group (n=24) and control group (n=24). All patients with diagnosis in accordance with the 2008 international septic shock and severe sepsis treatment guidelines were provided with comprehensive treatment and mechanical ventilation on the basis of analgesia and sedation. The patients in treatment group were given a loading dose of vecuronium during mechanical ventilation, started with 0.1 mg/kg up to 0.05 mg×kg(-1)×h(-1) for continuous intravenous infusion for 24-48 hours. The acute physiology and chronic health evaluation II (APACHEII) score, sequential organ failure assessment (SOFA), arterial oxygenation index (PaO2/FiO2), central venous oxygen saturation (ScvO2), arterial blood lactate (Lac), C-reactive protein (CRP) levels of two groups were compared before treatment and 48 hours after treatment, and 21-day mortality rate was finally compared. RESULTS: In moderate or severe ARDS group, there were no statistically significant difference in APACHEII score, SOFA score, PaO2/FiO2, ScvO2, Lac and CRP before treatment between two groups. APACHEII score, SOFA score, PaO2/FiO2, ScvO2, and Lac 48 hours after treatment were significantly improved in severe ARDS group compared with control group (APACHEII score: 16.58±2.41 vs. 19.79±3.52, t=3.679, P=0.010; SOFA score: 12.04±2.17 vs. 14.75±3.26, t=3.385, P=0.010; PaO2/FiO2: 159.31±22.57 mmHg vs. 131.81±34.93 mmHg, t=3.239, P=0.020; ScvO2: 0.673±0.068 vs. 0.572±0.142, t=3.137, P=0.030; Lac: 3.10±1.01 mmol/L vs. 4.39±1.72 mmol/L, t=3.161, P=0.030), while the value of CRP showed no significant difference (180.91±37.14 mg/L vs. 174.66±38.46 mg/L, t=0.572, P=0.570). 21-day mortality in treatment group was significantly lower than that in control group 20.8% (5/24) vs. 50.0% (12/24), χ(2)=4.463, P=0.035. In moderate ARDS group, each of the above clinical parameters were improved in both groups expect for CRP at 48 hours after treatment, but the indexes showed no statistically significant difference between two groups (all P>0.05). 21-day mortality rate in the treatment group was slightly lower than that in the control group which showed no statistically significant difference 16.7% (4/24) vs. 25.0% (6/24), χ(2)=0.505, P=0.477. CONCLUSIONS: The early use of NMBA treatment of patients with severe sepsis and severe ARDS cannot only improve the severity but also reduce 21-day mortality.