Fig. 1.

Proposed algorithm for NMBAs use in ARDS patients. NMBA use is suggested when moderate to severe ARDS is present. NMBAs plays a pivotal role in limiting decruitment and maintaining PEEP, allowing a reduction in swings of transpulmonary pressure due to strong inspiratory effort and expiratory alveolar collapse. ARDS: Acute respiratory distress syndrome; BGA: Blood gas analysis; BIS: Bispectral index; ICU: Intensive care unit; NMBA: Neuromuscular blocking agent; PBW: Predicted body weight; PEEP: Positive end-expiratory pressure; RASS: Richmond Agitation Sedation Scale.