80. RFJC 11 – ARDS Series – ROSE

The ROSE trial, published in 2019, fundamentally shifted clinical understanding of neuromuscular blockade in patients with early, severe acute respiratory distress syndrome (ARDS). By comparing 48 hours of deep sedation and paralysis against a light sedation strategy, the study demonstrated no mortality benefit, leading to its early termination for futility. While previous research suggested potential advantages to paralysis, the ROSE trial revealed that routine use increases the risk of ICU-acquired weakness and serious cardiovascular events. These findings indicate that neuromuscular blockade should not be used as a default treatment for ARDS. Instead, clinicians should reserve paralysis for specific scenarios, such as managing severe ventilator dyssynchrony, while prioritizing lung-protective ventilation and evidence-based practices like prone positioning to improve patient outcomes without the risks associated with unnecessary deep sedation.