Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
dc.contributor.author | Li Bassi, Gianluigi | |
dc.contributor.author | Gibbons, Kristen | |
dc.contributor.author | Suen, Jacky Y. | |
dc.contributor.author | Dalton, Heidi J. | |
dc.contributor.author | White, Nicole | |
dc.contributor.author | Corley, Amanda | |
dc.contributor.author | Shrapnel, Sally | |
dc.contributor.author | Hinton, Samuel | |
dc.contributor.author | Forsyth, Simon | |
dc.contributor.author | Laffey, John G. | |
dc.contributor.author | Fan, Eddy | |
dc.contributor.author | Fanning, Jonathon P. | |
dc.contributor.author | Panigada, Mauro | |
dc.contributor.author | Bartlett, Robert | |
dc.contributor.author | Brodie, Daniel | |
dc.contributor.author | Burrell, Aidan | |
dc.contributor.author | Chiumello, Davide | |
dc.contributor.author | Elhazmi, Alyaa | |
dc.contributor.author | Esperatti, Mariano | |
dc.contributor.author | Grasselli, Giacomo | |
dc.contributor.author | Hodgson, Carol | |
dc.contributor.author | Ichiba, Shingo | |
dc.contributor.author | Luna, Carlos | |
dc.contributor.author | Marwali, Eva | |
dc.contributor.author | Merson, Laura | |
dc.contributor.author | Murthy, Srinivas | |
dc.contributor.author | Nichol, Alistair | |
dc.contributor.author | Ogino, Mark | |
dc.contributor.author | Pelosi, Paolo | |
dc.contributor.author | Torres, Antoni | |
dc.contributor.author | Ng, Pauline Y. | |
dc.contributor.author | Fraser, John F. | |
dc.date.accessioned | 2022-05-22T00:03:57Z | |
dc.date.available | 2022-05-22T00:03:57Z | |
dc.date.issued | 2022-05-17 | |
dc.date.updated | 2022-05-22T00:03:57Z | |
dc.description.abstract | Abstract Background The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting. | |
dc.identifier.citation | Critical Care. 2022 May 17;26(1):141 | |
dc.identifier.doi | https://doi.org/10.1186/s13054-022-03983-5 | |
dc.identifier.uri | http://hdl.handle.net/1880/114693 | |
dc.language.rfc3066 | en | |
dc.rights.holder | The Author(s) | |
dc.title | Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis | |
dc.type | Journal Article |