A 37 -year-old woman i s admitted to the ICU for severe pancreatitis（胰腺炎） complicated by acute respiratory distress syndrome (ARDS ) requiring mechanical ventilation. She continues to have difficulty ventilating and agitation（焦虑） on increasing doses of fentanyl（芬太尼） and midazolam（咪达唑仑） (Versed) IV infusions. What is the most appropriate next step ?
A. Continue to increase midazolam (Versed) as tolerated（容忍）.
B. Change sedative agent from midazolam (Versed) to propofol（丙泊酚）.
C. Administer a neuromuscular blocking agent in addition to current regimen.
D. Administer a second analgesic（止痛） as difficulty in ventilating her and agitation are secondary to poorly controlled pain.
E. Provide a trial of pressure support ventilation.
答案解析：
部分患者无论是否服用有效剂量的抗焦虑药物，均可保持谵妄、激越，难以维持通气。如果对患者进行气管插管、机械通气和充分镇静，使用神经肌肉阻滞使患者瘫痪是一个很好的选择。在通气困难且经常激越的 ARDS 患者中，神经肌肉阻滞可能是帮助改善通气和气体交换的合理替代方案。
正确答案：C
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