{"id":"https://openalex.org/W7168564173","doi":"https://doi.org/10.1093/ajhp/zxag220","title":"Neuromuscular blocking agents for acute respiratory distress syndrome: Current controversies","display_name":"Neuromuscular blocking agents for acute respiratory distress syndrome: Current controversies","publication_year":2026,"publication_date":"2026-07-16","ids":{"openalex":"https://openalex.org/W7168564173","doi":"https://doi.org/10.1093/ajhp/zxag220","pmid":"https://pubmed.ncbi.nlm.nih.gov/42462166"},"language":"en","primary_location":{"id":"doi:10.1093/ajhp/zxag220","doi":"https://doi.org/10.1093/ajhp/zxag220","is_oa":false,"landing_page_url":"https://doi.org/10.1093/ajhp/zxag220","pdf_url":null,"source":{"id":"https://openalex.org/S105051383","display_name":"American Journal of Health-System Pharmacy","issn_l":"1079-2082","issn":["1079-2082","1535-2900"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-1","medline","norway-1"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"American Journal of Health-System Pharmacy","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5066659923","display_name":"Gretchen L. Sacha","orcid":"https://orcid.org/0000-0002-0070-8100","observed_orcids":["https://orcid.org/0000-0002-0070-8100"]},"institutions":[{"id":"https://openalex.org/I1316902750","display_name":"Cleveland Clinic","ror":"https://ror.org/03xjacd83","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1316902750"]},{"id":"https://openalex.org/I36373038","display_name":"Cleveland Clinic Lerner College of Medicine","ror":"https://ror.org/02x4b0932","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1316902750","https://openalex.org/I36373038"]},{"id":"https://openalex.org/I58956616","display_name":"Case Western Reserve University","ror":"https://ror.org/051fd9666","country_code":"US","type":"education","lineage":["https://openalex.org/I58956616"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Gretchen L Sacha","raw_affiliation_strings":["Department of Pharmacy, Cleveland Clinic, Cleveland, OH, and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University , Cleveland, OH ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pharmacy, Cleveland Clinic, Cleveland, OH, and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University , Cleveland, OH ,","institution_ids":["https://openalex.org/I1316902750","https://openalex.org/I36373038","https://openalex.org/I58956616"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5037477896","display_name":"Mojdeh S. Heavner","orcid":"https://orcid.org/0000-0003-3007-7685","observed_orcids":["https://orcid.org/0000-0003-3007-7685"]},"institutions":[{"id":"https://openalex.org/I126744593","display_name":"University of Maryland, Baltimore","ror":"https://ror.org/04rq5mt64","country_code":"US","type":"education","lineage":["https://openalex.org/I126744593"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Mojdeh S Heavner","raw_affiliation_strings":["Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy , Baltimore, MD ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy , Baltimore, MD ,","institution_ids":["https://openalex.org/I126744593"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5140965618","display_name":"Susan E Smith","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I165733156","display_name":"University of Georgia","ror":"https://ror.org/00te3t702","country_code":"US","type":"education","lineage":["https://openalex.org/I165733156"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Susan E Smith","raw_affiliation_strings":["Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy , Athens, GA ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy , Athens, GA ,","institution_ids":["https://openalex.org/I165733156"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5085732144","display_name":"Brian L. Erstad","orcid":"https://orcid.org/0000-0001-8909-9921","observed_orcids":["https://orcid.org/0000-0001-8909-9921"]},"institutions":[{"id":"https://openalex.org/I138006243","display_name":"University of Arizona","ror":"https://ror.org/03m2x1q45","country_code":"US","type":"education","lineage":["https://openalex.org/I138006243"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Brian L Erstad","raw_affiliation_strings":["Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy , Tucson, AZ ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy , Tucson, AZ ,","institution_ids":["https://openalex.org/I138006243"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":6,"corresponding_author_ids":["https://openalex.org/A5085732144"],"corresponding_institution_ids":["https://openalex.org/I138006243"],"apc_list":{"value":4448,"currency":"USD","value_usd":4448},"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.57677303,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10322","display_name":"Respiratory Support and Mechanisms","score":0.9164999723434448,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10322","display_name":"Respiratory Support and Mechanisms","score":0.9164999723434448,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10436","display_name":"Anesthesia and Sedative Agents","score":0.06639999896287918,"subfield":{"id":"https://openalex.org/subfields/2703","display_name":"Anesthesiology and Pain Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10867","display_name":"Intensive Care Unit Cognitive Disorders","score":0.00839999970048666,"subfield":{"id":"https://openalex.org/subfields/2706","display_name":"Critical Care and Intensive Care Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/neuromuscular-blocking-agents","display_name":"neuromuscular blocking agents","score":0.996999979019165},{"id":"https://openalex.org/keywords/acute-respiratory-distress-syndrome","display_name":"acute respiratory distress syndrome","score":1.0},{"id":"https://openalex.org/keywords/cisatracurium","display_name":"cisatracurium","score":0.9739999771118164},{"id":"https://openalex.org/keywords/sedation","display_name":"sedation","score":0.5339999794960022},{"id":"https://openalex.org/keywords/persistent-hypoxemia","display_name":"persistent hypoxemia","score":0.8629999756813049},{"id":"https://openalex.org/keywords/critically-ill-adults","display_name":"critically ill adults","score":0.7350000143051147},{"id":"https://openalex.org/keywords/mechanical-ventilation","display_name":"mechanical ventilation","score":0.37700000405311584}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8819000124931335},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.7896999716758728},{"id":"https://openalex.org/C2910841738","wikidata":"https://www.wikidata.org/wiki/Q3286619","display_name":"Neuromuscular Blocking Agents","level":2,"score":0.7833999991416931},{"id":"https://openalex.org/C2776348555","wikidata":"https://www.wikidata.org/wiki/Q344873","display_name":"ARDS","level":3,"score":0.7641000151634216},{"id":"https://openalex.org/C2777288759","wikidata":"https://www.wikidata.org/wiki/Q4164182","display_name":"Dosing","level":2,"score":0.7099000215530396},{"id":"https://openalex.org/C535046627","wikidata":"https://www.wikidata.org/wiki/Q30612","display_name":"Clinical trial","level":2,"score":0.5673999786376953},{"id":"https://openalex.org/C2776814716","wikidata":"https://www.wikidata.org/wiki/Q574801","display_name":"Sedation","level":2,"score":0.5333999991416931},{"id":"https://openalex.org/C2909621147","wikidata":"https://www.wikidata.org/wiki/Q344873","display_name":"Acute respiratory distress","level":3,"score":0.41749998927116394},{"id":"https://openalex.org/C2781413609","wikidata":"https://www.wikidata.org/wiki/Q7308373","display_name":"Regimen","level":2,"score":0.41440001130104065},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.3926999866962433},{"id":"https://openalex.org/C42219234","wikidata":"https://www.wikidata.org/wiki/Q131130","display_name":"Anesthesia","level":1,"score":0.3091999888420105},{"id":"https://openalex.org/C2776988050","wikidata":"https://www.wikidata.org/wiki/Q27108171","display_name":"Rocuronium","level":3,"score":0.3043000102043152},{"id":"https://openalex.org/C141983124","wikidata":"https://www.wikidata.org/wiki/Q188008","display_name":"Respiratory distress","level":2,"score":0.28600001335144043},{"id":"https://openalex.org/C2991859549","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Critically ill","level":2,"score":0.2685999870300293},{"id":"https://openalex.org/C3019480001","wikidata":"https://www.wikidata.org/wiki/Q4896847","display_name":"Best evidence","level":2,"score":0.2669000029563904}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1093/ajhp/zxag220","doi":"https://doi.org/10.1093/ajhp/zxag220","is_oa":false,"landing_page_url":"https://doi.org/10.1093/ajhp/zxag220","pdf_url":null,"source":{"id":"https://openalex.org/S105051383","display_name":"American Journal of Health-System Pharmacy","issn_l":"1079-2082","issn":["1079-2082","1535-2900"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-1","medline","norway-1"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"American Journal of Health-System Pharmacy","raw_type":"journal-article"},{"id":"pmid:42462166","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42462166","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.9907000064849854}],"sustainable_development_goals_aurora":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.7652922868728638}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":45,"referenced_works":["https://openalex.org/W1483703983","https://openalex.org/W1607569132","https://openalex.org/W1974404062","https://openalex.org/W1997664159","https://openalex.org/W2046031893","https://openalex.org/W2046612706","https://openalex.org/W2115186092","https://openalex.org/W2117029993","https://openalex.org/W2131093315","https://openalex.org/W2150866864","https://openalex.org/W2155900726","https://openalex.org/W2286228001","https://openalex.org/W2326892364","https://openalex.org/W2562857078","https://openalex.org/W2597571988","https://openalex.org/W2608341641","https://openalex.org/W2791905413","https://openalex.org/W2793513555","https://openalex.org/W2918440732","https://openalex.org/W2944755457","https://openalex.org/W2996010273","https://openalex.org/W3094508294","https://openalex.org/W3097093266","https://openalex.org/W4200099833","https://openalex.org/W4210885079","https://openalex.org/W4302283625","https://openalex.org/W4312194131","https://openalex.org/W4380871934","https://openalex.org/W4386001301","https://openalex.org/W4389179209","https://openalex.org/W4390106009","https://openalex.org/W4390658677","https://openalex.org/W4391131356","https://openalex.org/W4391309404","https://openalex.org/W4403628275","https://openalex.org/W4407910517","https://openalex.org/W4408961648","https://openalex.org/W4410226230","https://openalex.org/W4411997366","https://openalex.org/W4413025000","https://openalex.org/W4415807554","https://openalex.org/W4416992091","https://openalex.org/W7116650586","https://openalex.org/W7128765972","https://openalex.org/W7133350133"],"related_works":[],"abstract_inverted_index":{"PURPOSE:":[0],"The":[1],"purpose":[2],"of":[3,20,131,154,174,182],"this":[4],"paper":[5,141],"is":[6,42,51],"to":[7,17],"discuss":[8],"the":[9,18,95,98,117,121,129,151],"controversies":[10,145],"and":[11,34,50,56,78,94,138,167,172,201,204,217],"challenges":[12],"in":[13,25,46,70,92,97,115,133,149,184],"clinical":[14,59,127,178],"decision-making":[15],"related":[16],"use":[19,148,173,181],"neuromuscular":[21],"blocking":[22],"agents":[23],"(NMBAs)":[24],"adult":[26],"patients":[27,49,71,157,185],"with":[28,53,72,87,111,186],"acute":[29],"respiratory":[30],"distress":[31],"syndrome":[32],"(ARDS)":[33],"identify":[35],"directions":[36],"for":[37,67,108],"future":[38],"research.":[39],"SUMMARY:":[40],"ARDS":[41,187],"a":[43,103],"common":[44],"occurrence":[45],"critically":[47],"ill":[48],"associated":[52],"high":[54],"morbidity":[55],"mortality.":[57],"Four":[58],"practice":[60,134],"guidelines":[61,179],"published":[62],"since":[63],"2020":[64],"provide":[65],"recommendations":[66,198],"NMBA":[68,76,147,169,200,211],"administration":[69],"ARDS.":[73],"Recommendations":[74],"regarding":[75],"selection":[77],"dosing":[79,203,214],"are":[80,189],"largely":[81],"derived":[82],"from":[83,160],"2":[84],"multicenter":[85],"trials":[86,101],"discordant":[88],"results,":[89],"one":[90],"conducted":[91],"France":[93],"other":[96],"US.":[99],"Both":[100],"utilized":[102],"fixed-rate,":[104],"high-dose":[105],"cisatracurium":[106],"infusion":[107],"48":[109],"hours,":[110],"mortality":[112],"benefit":[113,153,159],"observed":[114],"only":[116],"French":[118],"trial.":[119],"Despite":[120],"regimen":[122],"being":[123],"consistent":[124],"between":[125],"these":[126],"trials,":[128],"utilization":[130],"NMBAs":[132,163,183],"has":[135],"significant":[136],"heterogeneity":[137],"variability.":[139],"This":[140],"will":[142],"address":[143],"5":[144],"surrounding":[146],"ARDS:":[150],"mechanistic":[152],"NMBAs,":[155,161],"which":[156],"derive":[158],"how":[162],"should":[164,209],"be":[165],"dosed":[166],"administered,":[168],"agent":[170,212],"selection,":[171,213],"sedation.":[175,193],"CONCLUSION:":[176],"Current":[177],"suggest":[180],"who":[188],"persistently":[190],"hypoxemic":[191],"despite":[192],"However,":[194],"they":[195],"lack":[196],"specific":[197],"on":[199],"sedation":[202],"titration":[205],"approaches.":[206,219],"Future":[207],"studies":[208],"investigate":[210],"regimens,":[215],"duration,":[216],"monitoring":[218]},"counts_by_year":[],"updated_date":"2026-08-21T09:56:20.448147","created_date":"2026-07-17T00:00:00"}
