{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T01:13:25Z","timestamp":1773450805920,"version":"3.50.1"},"reference-count":77,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T00:00:00Z","timestamp":1663545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients\u2019 self-inflicted lung injury. Moreover, NMBAs can harmonize the patient\u2013ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the \u201cwar\u201d conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS.<\/jats:p>","DOI":"10.3390\/jpm12091538","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T21:47:27Z","timestamp":1663624047000},"page":"1538","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2412-5388","authenticated-orcid":false,"given":"Vasiliki","family":"Tsolaki","sequence":"first","affiliation":[{"name":"Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4444-0967","authenticated-orcid":false,"given":"George E.","family":"Zakynthinos","sequence":"additional","affiliation":[{"name":"Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"},{"name":"Third Department of Cardiology, Sotiria General Hospital, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria-Eirini","family":"Papadonta","sequence":"additional","affiliation":[{"name":"Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fotini","family":"Bardaka","sequence":"additional","affiliation":[{"name":"Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2491-2886","authenticated-orcid":false,"given":"George","family":"Fotakopoulos","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8846-519X","authenticated-orcid":false,"given":"Ioannis","family":"Pantazopoulos","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demosthenes","family":"Makris","sequence":"additional","affiliation":[{"name":"Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Epaminondas","family":"Zakynthinos","sequence":"additional","affiliation":[{"name":"Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(67)90168-7","article-title":"Acute Respiratory distress in adults","volume":"2","author":"Ashbaugh","year":"1967","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1001\/jama.2017.21907","article-title":"Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment","volume":"319","author":"Fan","year":"2018","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"LUNG SAFE Investigators; ESICM Trials Group. 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