L’usage des curares en réanimation répond essentiellement a deux objectifs : améliorer les conditions d’intubation et faciliter la ventilation des patients en SDRA. Les conditions de l’intubation qui sont souvent celles de l’urgence imposent l’administration d’un curare d’action rapide : succinylcholine ou rocuronium. Le cisatracurium est le curare de référence pour la curarisation continue. La curarisation diminue les pressions intra-thoraciques et améliore les échanges gazeux mais pas la survie des patients ayant un ARDS. La relation entre neuromyopathie de réanimation et curarisation reste discutée.

The use of muscle relaxants in intensive care patients aims facilitating tracheal intubation and improving mechanical ventilation in ARDS patients. Since tracheal intubation is performed most of the time in emergency, succinylcholine is the gold standard for rapid sequence induction avoiding gastric content inhalation. However succinylcholine has contra-indications that favour the use of rocuronium in some patients. Patients who require muscle paralysis to be maintained, receive most of the time a continuous infusion of cisatracurium. Continuous administration of muscle relaxants improves gas exchanges and aims decreasing barotrauma in ARDS patients. Muscle relaxant administration in ICU patients is thought to be associated with ICU-acquired neuromuscular pathology although this remains to be clearly demonstrated owing to the multiple mechanisms that could be implicated.