If the patient has severe or rapidly worsening ARDS, a short course (48 hours) of neuromuscular blockade may facilitate the continued use of Lung Protective Ventilation (LPV) while eliminating such problems as ventilator dyssynchrony.28 This strategy also carries a survival benefit in patients with confirmed ARDS when used early in the course of disease (within 48 hours). Cisatricurium (Nimbex®) minimizes the risk of ICU-related neuropathy or myelopathy, as compared to other neuromuscular blockers, and does not require dose adjustment in renal or hepatic insufficiency. Thus, cisatricurium is the preferred neuromuscular blocking agent in patients with ARDS.29, 30