Intérêt d'une curarisation systématique précoce de 48 heures sur le pronostic des patients présentant un syndrome de détresse respiratoire aiguë. Étude ACURASYS. Présentation du protocole

Acute respiratory distress syndrome (ARDS) is associated with a mortality of 40% to 60%. Numerous sophisticated treatments have been evaluated. However, the use of neuromuscular blocking agents (NMBA) remains poorly studied in this indication. In a recently published study (Gainnier et al., Crit Care Med 2004), our group reported a persistent oxygenation improvement in ARDS patients paralyzed during the first 48 h after the onset of ARDS as compared with ARDS patients who did not receive NMBA. One plausible explanation would be that tidal volume is much more homogenously distributed when patients are paralyzed. In a very recently published study, we have shown that NMBA use is associated with a significant reduction of pro-inflammatory cytokines in BAL and blood samples (Forel et al., Crit Care Med 2006). When the patients included in these two studies are considered together, we found a significant reduction in the mortality rate. These data have not been published because these two studies were not designed to study the outcome. However, we decided to perform a multicenter double-blind, placebo-controlled prospective trial in order to demonstrate that the early use of a short period of paralysis is associated with a better outcome of ARDS patients. A total of 340 patients need to be included in the twenty ICUs participating in this trial.