Current clinical guidelines, such as those from the Surviving Sepsis Campaign and ARDSNet, recommend short-term NMBA use for patients with moderate to severe ARDS who exhibit persistent ventilator dyssynchrony or high plateau pressures despite deep sedation . However, they do not provide clear recommendations regarding the mode of administration. As a result, clinicians are left to extrapolate from limited or indirect evidence, which may lead to practice variation, uncertainty, and suboptimal care. This pilot randomized controlled trial is designed to directly address this critical gap by comparing intermittent bolus administration versus continuous infusion of NMBAs in a pragmatic, real-world ICU setting. The study will assess feasibility metrics necessary to plan a definitive trial and generate preliminary clinical data on safety and effectiveness. By clarifying the comparative benefits and risks of each approach, the results may influence practice guidelines, reduce variation in care, and improve patient outcomes and reduce practice variation.patient outcomes, optimize resource use, and inform future guidelines on the management of moderate to severe ARDS.
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Recruitment rate among eligible patients
Timeframe: Within 48 hours of meeting ARDS criteria
Protocol adherence rate
Timeframe: for the first 28 days of mechanical ventilation
Proportion of missing baseline characteristics and outcomes
Timeframe: First 28 days of invasive ventilation post ARDS diagnosis.
Compositive Safety
Timeframe: First 28 days of invasive ventilation post ARDS diagnosis.