Crit Care
. 2022 May 17;26(1):141.
doi: 10.1186/s13054-022-03983-5.
Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
Gianluigi Li Bassi # 1 2 3 4 5 6 , Kristen Gibbons # 7 , Jacky Y Suen 8 9 , Heidi J Dalton 10 , Nicole White 11 , Amanda Corley 8 9 , Sally Shrapnel 9 12 , Samuel Hinton 9 , Simon Forsyth 9 , John G Laffey 13 , Eddy Fan 14 , Jonathon P Fanning 8 9 15 16 , Mauro Panigada 17 , Robert Bartlett 18 , Daniel Brodie 19 , Aidan Burrell 20 , Davide Chiumello 21 22 , Alyaa Elhazmi 23 , Mariano Esperatti 24 , Giacomo Grasselli 14 22 , Carol Hodgson 20 , Shingo Ichiba 25 , Carlos Luna 26 , Eva Marwali 27 , Laura Merson 28 , Srinivas Murthy 29 30 , Alistair Nichol 20 31 32 , Mark Ogino 33 , Paolo Pelosi 34 35 , Antoni Torres 36 37 , Pauline Yeung Ng 38 , John F Fraser 8 9 36 11 15 16 , COVID-19 Critical Care Consortium
Collaborators, Affiliations
- PMID: 35581612
- DOI: 10.1186/s13054-022-03983-5
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.
Keywords: COVID-19; Intensive care unit; Mechanical ventilation; Neuromuscular blocking agent; SARS-CoV-2.