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Li Bassi, Gianluigi; Gibbons, Kristen; Suen, Jacky Y.; Dalton, Heidi J.; White, Nicole; Corley, Amanda; Shrapnel, Sally; Hinton, Samuel; Forsyth, Simon; Laffey, John G.; Fan, Eddy; Fanning, Jonathon P.; Panigada, Mauro; Bartlett, Robert; Brodie, Daniel; Burrell, Aidan; Chiumello, Davide; Elhazmi, Alyaa; Esperatti, Mariano; Grasselli, Giacomo; Hodgson, Carol; Ichiba, Shingo; Luna, Carlos; Marwali, Eva; Merson, Laura; Murthy, Srinivas; Nichol, Alistair; Ogino, Mark; Pelosi, Paolo; Torres, Antoni; Ng, Pauline Y.; Fraser, John F.

BioMed Central

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.

Article

eng

Vancouver : University of British Columbia Library

10.14288/1.0417406

Medicine, Faculty of; Non UBC; Pediatrics, Department of

10.1186/s13054-022-03983-5

Faculty; Researcher

http://creativecommons.org/licenses/by/4.0/