Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome (ROSE)
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Educational summary — always verify with primary sourceACURASYS (2010) suggested NMBAs improved mortality in severe ARDS. However, the control arm used deep sedation. ROSE was designed to compare NMBAs vs. light sedation (the current standard).
Multicenter RCT (48 US centers, n=1,006) comparing cisatracurium for 48 hours + deep sedation vs. light sedation alone in moderate-to-severe ARDS (P/F <150).
No difference in 90-day in-hospital mortality (42.5% vs 42.8%, p=0.93). No difference in ventilator-free days, ICU-free days, or adverse events.
Routine early NMBAs do NOT improve outcomes in ARDS when compared to light sedation. NMBAs should be reserved for specific indications: severe patient-ventilator dyssynchrony, refractory hypoxemia, or prone positioning facilitation.
Stopped early for futility. Higher-than-expected crossover in the light sedation arm.
Know ACURASYS vs ROSE together. ROSE is the definitive trial. NMBAs = not routinely recommended. Light sedation is now standard.
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