Today, we are showcasing the five recommendations included in the Society of Critical Care Medicine (SCCM) guideline on Administration of Neuromuscular Blockade in Adults With Acute Respiratory Distress Syndrome. Neuromuscular blocking agents (NMBAs) have been associated with potential benefits in adult patients with acute respiratory distress syndrome (ARDS). The guideline provides recommendations for the administration of NMBAs in critically ill adults with ARDS, emphasizing the importance of patient-specific considerations when tailoring treatment decisions.

All five recommendations are classified as conditional recommendations. The first recommendation is the only recommendation not assigned a "very low" certainty of evidence, as it is supported by a "low" certainty of evidence. View the full-text version for the most thorough explanation of the following recommendations. 

Recommendations from the 2026 SCCM Guideline on Neuromuscular Blockade in Adults with ARDS
  • We suggest using NMBAs over not using NMBAs in adults with ARDS with PaO2/FiO2 < 150 who are persistently hypoxemic and/or not achieving mechanical ventilation targets on sedation.
  • We suggest using either a fixed-dose strategy without monitoring depth of neuromuscular blockade, or a titration-based strategy by monitoring depth of neuromuscular blockade for adults with ARDS.
  • We suggest using either a scale-based evaluation or nonscale-based evaluation for depth of analgesia and sedation before initiating NMBA for adult patients with ARDS.
  • We suggest using either a monitoring-based strategy or no monitoring of depth of analgesia and sedation in adults with ARDS who are receiving NMBAs.
  • We suggest either administering neuromuscular blockade or not administering neuromuscular blockade in adult patients who are prone for ARDS.

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