Early neuromuscular blockade in acute respiratory distress syndrome: to personalize or paralyze?

Acute respiratory distress syndrome (ARDS) is an inflammatory condition of the lungs characterized by acute hypoxemic respiratory failure and non-cardiogenic pulmonary edema (1). This is typically caused by direct lung injury (e.g., pneumonia); however, it can also be the result of indirect injury as well (e.g., non-pulmonary sepsis). ARDS is associated with significant mortality (1-3). Severity is graded using the arterial to inspired oxygen ratio (PF ratio) and can prognosticate survival and ventilator-free days (1-3). Those that survive are often left with significant reductions in functional capacity (4).