tetano
Editor, Senior Moderator
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[SUP] #[/SUP][SUP] 1 2 3 4 5 6 [/SUP], Kristen Gibbons[SUP] #[/SUP][SUP] 7 [/SUP], Jacky Y Suen[SUP] 8 9 [/SUP], Heidi J Dalton[SUP] 10 [/SUP], Nicole White[SUP] 11 [/SUP], Amanda Corley[SUP] 8 9 [/SUP], Sally Shrapnel[SUP] 9 12 [/SUP], Samuel Hinton[SUP] 9 [/SUP], Simon Forsyth[SUP] 9 [/SUP], John G Laffey[SUP] 13 [/SUP], Eddy Fan[SUP] 14 [/SUP], Jonathon P Fanning[SUP] 8 9 15 16 [/SUP], Mauro Panigada[SUP] 17 [/SUP], Robert Bartlett[SUP] 18 [/SUP], Daniel Brodie[SUP] 19 [/SUP], Aidan Burrell[SUP] 20 [/SUP], Davide Chiumello[SUP] 21 22 [/SUP], Alyaa Elhazmi[SUP] 23 [/SUP], Mariano Esperatti[SUP] 24 [/SUP], Giacomo Grasselli[SUP] 14 22 [/SUP], Carol Hodgson[SUP] 20 [/SUP], Shingo Ichiba[SUP] 25 [/SUP], Carlos Luna[SUP] 26 [/SUP], Eva Marwali[SUP] 27 [/SUP], Laura Merson[SUP] 28 [/SUP], Srinivas Murthy[SUP] 29 30 [/SUP], Alistair Nichol[SUP] 20 31 32 [/SUP], Mark Ogino[SUP] 33 [/SUP], Paolo Pelosi[SUP] 34 35 [/SUP], Antoni Torres[SUP] 36 37 [/SUP], Pauline Yeung Ng[SUP] 38 [/SUP], John F Fraser[SUP] 8 9 36 11 15 16 [/SUP], COVID-19 Critical Care Consortium
Collaborators, Affiliations
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.
. 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[SUP] #[/SUP][SUP] 1 2 3 4 5 6 [/SUP], Kristen Gibbons[SUP] #[/SUP][SUP] 7 [/SUP], Jacky Y Suen[SUP] 8 9 [/SUP], Heidi J Dalton[SUP] 10 [/SUP], Nicole White[SUP] 11 [/SUP], Amanda Corley[SUP] 8 9 [/SUP], Sally Shrapnel[SUP] 9 12 [/SUP], Samuel Hinton[SUP] 9 [/SUP], Simon Forsyth[SUP] 9 [/SUP], John G Laffey[SUP] 13 [/SUP], Eddy Fan[SUP] 14 [/SUP], Jonathon P Fanning[SUP] 8 9 15 16 [/SUP], Mauro Panigada[SUP] 17 [/SUP], Robert Bartlett[SUP] 18 [/SUP], Daniel Brodie[SUP] 19 [/SUP], Aidan Burrell[SUP] 20 [/SUP], Davide Chiumello[SUP] 21 22 [/SUP], Alyaa Elhazmi[SUP] 23 [/SUP], Mariano Esperatti[SUP] 24 [/SUP], Giacomo Grasselli[SUP] 14 22 [/SUP], Carol Hodgson[SUP] 20 [/SUP], Shingo Ichiba[SUP] 25 [/SUP], Carlos Luna[SUP] 26 [/SUP], Eva Marwali[SUP] 27 [/SUP], Laura Merson[SUP] 28 [/SUP], Srinivas Murthy[SUP] 29 30 [/SUP], Alistair Nichol[SUP] 20 31 32 [/SUP], Mark Ogino[SUP] 33 [/SUP], Paolo Pelosi[SUP] 34 35 [/SUP], Antoni Torres[SUP] 36 37 [/SUP], Pauline Yeung Ng[SUP] 38 [/SUP], John F Fraser[SUP] 8 9 36 11 15 16 [/SUP], 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.