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1、ThenewenglandjournalofmedicinecorrespondenceNeuromuscularBlockersandARDSTotheEditor:InthestudyreportedonbyPa-prolongedmechanicalventilation,particularlyifpazianetal.(Sept.16issue),1patientswiththetheyareslowtoawaken.3acuterespiratorydistresssyndrome(ARDS)tre
2、at-JohnW.Devlin,Pharm.D.edearlywithcisatracuriumhadimproved90-dayNortheasternUniversitysurvivalandanincreasednumberofventilator-Boston,MAfreedays.Weareconcernedaboutanumberofj.devlin@neu.edumethodologiclimitationsthatdetractfromtheErikGarpestad,M.D.reliabili
3、tyofthefindings.First,consideringthatNicholasS.Hill,M.D.patientswhoarenotparalyzedcantriggertheTuftsMedicalCenterBoston,MAventilatorandparalyzedpatientscannot,adequateNopotentialconflictofinterestrelevanttothisletterwasre-blindingofstudy-groupassignmentsamon
4、gcare-ported.giverswouldseemtohavebeennearlyimpossi-1.PapazianL,ForelJM,GacouinA,etal.Neuromuscularble.Furthermore,patient−ventilatordyssynchronyblockersinearlyacuterespiratorydistresssyndrome.NEnglJwasnotformallymonitored,norwerestrategiesMed2010;363:1107-1
5、6.todealwithitprespecified.2Lackingthat,itis2.TremblayLN,SlutskyAS.Ventilator-inducedlunginjury:fromthebenchtothebedside.IntensiveCareMed2006;32:24-conceivablethatinadequatemanagementofdys-33.synchronyintheplacebogroupcouldhavepre-3.SharsharT,Bastuji-GarinS,
6、StevensRD,etal.Presenceanddisposedtoworseoutcomes.Finally,theMedicalseverityofintensivecareunit-acquiredparesisattimeofawak-eningareassociatedwithincreasedintensivecareunitandhos-ResearchCouncil(MRC)scalemethodusedtopitalmortality.CritCareMed2009;37:3047-53.
7、evaluatemuscleweaknesswaslimitedto28days(ortodischargefromtheintensivecareunit[ICU]),adurationthatmaybetoobrieftorecog-TotheEditor:InthestudybyPapazianandcol-nizemuscleweaknessinpatientswhorequireleagues,therewasnoclearexplanationfortheobservedincreaseinsurv
8、ivalinthegrouptreatedthisweek’sletterswithparalyticagents.1Sincetheeffectivenessoftheneuromuscularblockingagentwasnotas-2562NeuromuscularBlockersandARDSsessedwithtrain-of-fourstimulation,howcan2
