Paediatric Ards Neuromuscular Blockade Study

Inclusion criteria * Informed consent * Age younger than 5 years * Need for mechanical ventilation with tidal volume 5 - 8 mL/kg ideal bodyweight and PEEP equal to or greater than 5 cmH2O * Early moderate - to - severe paediatric acute respiratory distress syndrome originating from any cause, i.e. acute onset of disease, and oxygenation index greater than 12, and one or more (bilateral) infiltrates on chest radiograph, and no evidence of left ventricular failure or fluid overload, and within the first 48 hours of PICU admission * Sedation defined by Comfort - B scale between 9 - 12 Exclusion criteria * No informed consent * Known allergy or intolerance to rocuronium * Continuous administration of neuromuscular blockade prior at the time of meeting the criteria for PARDS * Chronic respiratory failure on home ventilation * Intracranial hypertension * Bone marrow transplantation * Immunocompromised patients (congenital or acquired) * Pre-existing pulmonary hypertension * Congenital heart disease with left - to - right shunting * Cyanotic congenital heart disease * Expected duration of mechanical ventilation less than 48 hours * Withdrawal of life - sustaining treatment